Provider Demographics
NPI:1437893906
Name:OWL AND EAGLE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:OWL AND EAGLE ENTERPRISES, LLC
Other - Org Name:OWL & EAGLE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-736-9697
Mailing Address - Street 1:430 INDIANA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5012
Mailing Address - Country:US
Mailing Address - Phone:303-736-9697
Mailing Address - Fax:720-306-5464
Practice Address - Street 1:7350 E PROGRESS PL STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2130
Practice Address - Country:US
Practice Address - Phone:303-736-9697
Practice Address - Fax:720-306-5464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWL AND EAGLE ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000206121Medicaid