Provider Demographics
NPI:1679002034
Name:RUKECHA LLC
Entity Type:Organization
Organization Name:RUKECHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:IFULU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-272-8496
Mailing Address - Street 1:1425 S ENSENADA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5531
Mailing Address - Country:US
Mailing Address - Phone:720-272-8496
Mailing Address - Fax:
Practice Address - Street 1:1425 S ENSENADA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017
Practice Address - Country:US
Practice Address - Phone:720-272-8496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid