Provider Demographics
NPI:1508289612
Name:BAMBOO HOLDINGS, LLC
Entity Type:Organization
Organization Name:BAMBOO HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-388-0386
Mailing Address - Street 1:3955 E EXPOSITION AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5031
Mailing Address - Country:US
Mailing Address - Phone:720-388-0386
Mailing Address - Fax:866-889-6637
Practice Address - Street 1:3955 E EXPOSITION AVE STE 104
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5031
Practice Address - Country:US
Practice Address - Phone:720-388-0386
Practice Address - Fax:866-889-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service