Provider Demographics
NPI:1508383316
Name:BOULDER TWILIGHT INC
Entity Type:Organization
Organization Name:BOULDER TWILIGHT INC
Other - Org Name:VISITING ANGELS OF BOULDER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-232-9999
Mailing Address - Street 1:1930 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1985
Mailing Address - Country:US
Mailing Address - Phone:303-828-2664
Mailing Address - Fax:303-274-8511
Practice Address - Street 1:1930 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1985
Practice Address - Country:US
Practice Address - Phone:303-828-2664
Practice Address - Fax:303-274-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04O500253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04O500OtherCOLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT