Provider Demographics
NPI:1639607633
Name:SOUL ALCHEMY LLC
Entity Type:Organization
Organization Name:SOUL ALCHEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOGA INSTRUCTOR AND LIFE COACH
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:YI, ACHE HC
Authorized Official - Phone:720-418-9492
Mailing Address - Street 1:9341 TELLER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4812
Mailing Address - Country:US
Mailing Address - Phone:303-420-0581
Mailing Address - Fax:
Practice Address - Street 1:14231 E 4TH AVE STE 370
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8720
Practice Address - Country:US
Practice Address - Phone:720-418-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1912435918Medicaid