Provider Demographics
NPI:1790137495
Name:AITHR DEALER INC
Entity Type:Organization
Organization Name:AITHR DEALER INC
Other - Org Name:AGING IN THE HOME REMODELERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-504-0126
Mailing Address - Street 1:1998 RUFFIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5913
Mailing Address - Country:US
Mailing Address - Phone:303-222-3202
Mailing Address - Fax:
Practice Address - Street 1:3900 S WADSWORTH BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2203
Practice Address - Country:US
Practice Address - Phone:720-504-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRSTSTREET FOR BOOMERS AND BEYOND, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2014605400332B00000X
NE44690332B00000X
PAPA112522332B00000X
WACC AITHRDI864M9332B00000X
CA1001047332B00000X
LA882879332B00000X
MD132123332B00000X
MNBC663730332B00000X
NV79204332B00000X
NM379703332B00000X
OR206632332B00000X
SC44179332B00000X
VA2705156243332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies