Provider Demographics
NPI:1134505290
Name:BILI BLANKET BABY, LLC
Entity Type:Organization
Organization Name:BILI BLANKET BABY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUKHOTSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-352-9993
Mailing Address - Street 1:4450 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:877-593-2454
Mailing Address - Fax:800-231-0352
Practice Address - Street 1:4450 ARAPAHOE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:877-593-2454
Practice Address - Fax:800-231-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28567510Medicaid