Provider Demographics
NPI:1902196520
Name:BOBERIAN BASIX, INC
Entity Type:Organization
Organization Name:BOBERIAN BASIX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING PERSON
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-487-4943
Mailing Address - Street 1:8795 RALSTON RD STE 126
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2320
Mailing Address - Country:US
Mailing Address - Phone:303-456-0611
Mailing Address - Fax:303-487-4950
Practice Address - Street 1:8795 RALSTON RD STE 126
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2320
Practice Address - Country:US
Practice Address - Phone:303-456-0611
Practice Address - Fax:303-487-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO977011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC94946Medicare UPIN