Provider Demographics
NPI:1659014819
Name:HOLY HOST HOME AGENCY LLC
Entity Type:Organization
Organization Name:HOLY HOST HOME AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHLEHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MERID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-492-6027
Mailing Address - Street 1:4815 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7455
Mailing Address - Country:US
Mailing Address - Phone:720-492-6027
Mailing Address - Fax:
Practice Address - Street 1:4815 LISBON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7455
Practice Address - Country:US
Practice Address - Phone:720-492-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities