Provider Demographics
NPI:1790491025
Name:DEDICATED AGENCY LLC
Entity Type:Organization
Organization Name:DEDICATED AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-587-7622
Mailing Address - Street 1:590 S LAREDO CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-2106
Mailing Address - Country:US
Mailing Address - Phone:720-587-7622
Mailing Address - Fax:
Practice Address - Street 1:590 S LAREDO CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-2106
Practice Address - Country:US
Practice Address - Phone:720-587-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services