Provider Demographics
NPI:1376151282
Name:ROUNDUP FELLOWSHIP INC
Entity Type:Organization
Organization Name:ROUNDUP FELLOWSHIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-745-7021
Mailing Address - Street 1:3443 S GALENA ST STE 310
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5079
Mailing Address - Country:US
Mailing Address - Phone:720-745-7021
Mailing Address - Fax:303-353-8305
Practice Address - Street 1:3443 S GALENA ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5079
Practice Address - Country:US
Practice Address - Phone:303-757-8008
Practice Address - Fax:303-353-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142021Medicaid