Provider Demographics
NPI:1821201484
Name:M.O.D. INC.,
Entity Type:Organization
Organization Name:M.O.D. INC.,
Other - Org Name:NADIA PERSONAL CARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-831-4277
Mailing Address - Street 1:2117 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5210
Mailing Address - Country:US
Mailing Address - Phone:303-831-4277
Mailing Address - Fax:303-831-1270
Practice Address - Street 1:2117 DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5210
Practice Address - Country:US
Practice Address - Phone:303-831-4277
Practice Address - Fax:303-831-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10M224251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16436571Medicaid