Provider Demographics
NPI:1215534516
Name:LILY LLC
Entity Type:Organization
Organization Name:LILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FITSUM
Authorized Official - Middle Name:T
Authorized Official - Last Name:TEFERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-421-7972
Mailing Address - Street 1:1679 S ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5765
Mailing Address - Country:US
Mailing Address - Phone:720-421-7972
Mailing Address - Fax:
Practice Address - Street 1:1679 S ELKHART ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5765
Practice Address - Country:US
Practice Address - Phone:720-421-7972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)