Provider Demographics
NPI:1598017188
Name:DALIFE LLC
Entity Type:Organization
Organization Name:DALIFE LLC
Other - Org Name:ARTEMIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COPANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-955-8314
Mailing Address - Street 1:10431 TOWN CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6076
Mailing Address - Country:US
Mailing Address - Phone:303-955-8314
Mailing Address - Fax:303-993-4013
Practice Address - Street 1:10431 TOWN CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6076
Practice Address - Country:US
Practice Address - Phone:303-955-8314
Practice Address - Fax:303-993-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH09541Medicare UPIN
COG90049Medicare UPIN