Provider Demographics
NPI:1588209670
Name:CGL CPA, LLC
Entity Type:Organization
Organization Name:CGL CPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:720-318-5102
Mailing Address - Street 1:1420 KENTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3580
Mailing Address - Country:US
Mailing Address - Phone:303-344-8665
Mailing Address - Fax:303-366-6293
Practice Address - Street 1:1420 KENTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-3580
Practice Address - Country:US
Practice Address - Phone:303-344-8665
Practice Address - Fax:303-366-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty