Provider Demographics
NPI:1639520315
Name:AVIVA HOME CARE LLC
Entity Type:Organization
Organization Name:AVIVA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKAEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-217-8607
Mailing Address - Street 1:4340 E KENTUCKY AVE
Mailing Address - Street 2:# 306
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2060
Mailing Address - Country:US
Mailing Address - Phone:720-420-4369
Mailing Address - Fax:
Practice Address - Street 1:4340 E KENTUCKY AVE
Practice Address - Street 2:# 306
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2060
Practice Address - Country:US
Practice Address - Phone:720-420-4369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04M642251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health