Provider Demographics
NPI:1417132408
Name:ACORN CREEK INC
Entity Type:Organization
Organization Name:ACORN CREEK INC
Other - Org Name:PAMPERED PASSIONS FINE LINGERIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-346-8450
Mailing Address - Street 1:9615 E COUNTY LINE RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-346-8450
Mailing Address - Fax:303-858-8223
Practice Address - Street 1:9615 E COUNTY LINE RD
Practice Address - Street 2:UNIT D
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-346-8450
Practice Address - Fax:303-858-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5380150001Medicare NSC