Provider Demographics
NPI:1447605829
Name:VENEZIA INNOVATIVE SERVICES
Entity Type:Organization
Organization Name:VENEZIA INNOVATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DZAKPASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-297-1002
Mailing Address - Street 1:15343 E 6TH AVE
Mailing Address - Street 2:UNIT- F
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9009
Mailing Address - Country:US
Mailing Address - Phone:303-537-5078
Mailing Address - Fax:303-856-7203
Practice Address - Street 1:15343 E 6TH AVE
Practice Address - Street 2:UNIT- F
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9074
Practice Address - Country:US
Practice Address - Phone:303-537-5078
Practice Address - Fax:303-856-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30504261Medicaid
CO55675051Medicaid