Provider Demographics
NPI:1174824551
Name:ULTIMED HOME SUPPLIES
Entity Type:Organization
Organization Name:ULTIMED HOME SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAKTINSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-261-5494
Mailing Address - Street 1:2575 S SYRACUSE WAY
Mailing Address - Street 2:H204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3832
Mailing Address - Country:US
Mailing Address - Phone:303-261-5494
Mailing Address - Fax:
Practice Address - Street 1:2575 S SYRACUSE WAY
Practice Address - Street 2:H204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3832
Practice Address - Country:US
Practice Address - Phone:303-261-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies