Provider Demographics
NPI:1467731059
Name:PHASE ONE
Entity Type:Organization
Organization Name:PHASE ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-518-2142
Mailing Address - Street 1:1560 S QUEBEC WAY
Mailing Address - Street 2:# 55
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5681
Mailing Address - Country:US
Mailing Address - Phone:303-518-2142
Mailing Address - Fax:
Practice Address - Street 1:1560 S QUEBEC WAY
Practice Address - Street 2:# 55
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5681
Practice Address - Country:US
Practice Address - Phone:303-518-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services