Provider Demographics
NPI:1871509315
Name:COLORADO WHEELCHAIR, LLC
Entity Type:Organization
Organization Name:COLORADO WHEELCHAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GAITTEN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:303-684-8852
Mailing Address - Street 1:745 TANAGER CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2697
Mailing Address - Country:US
Mailing Address - Phone:303-684-8852
Mailing Address - Fax:800-650-9604
Practice Address - Street 1:745 TANAGER CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2697
Practice Address - Country:US
Practice Address - Phone:303-684-8852
Practice Address - Fax:800-650-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80204368Medicaid
CO80204368Medicaid