Provider Demographics
NPI:1972857183
Name:ENTAVIDA LLC
Entity Type:Organization
Organization Name:ENTAVIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-940-8531
Mailing Address - Street 1:6000 E EVANS AVE STE 1-341
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5428
Mailing Address - Country:US
Mailing Address - Phone:303-951-4323
Mailing Address - Fax:877-926-0262
Practice Address - Street 1:6000 E EVANS AVE STE 1-341
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5428
Practice Address - Country:US
Practice Address - Phone:303-951-4323
Practice Address - Fax:877-926-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty