Provider Demographics
NPI:1457715864
Name:ORR, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ORR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 COUNTY ROAD GG.5
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-9456
Mailing Address - Country:US
Mailing Address - Phone:719-456-0045
Mailing Address - Fax:
Practice Address - Street 1:14900 COUNTY ROAD GG.5
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-9456
Practice Address - Country:US
Practice Address - Phone:719-456-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONOT REQUIRED - BENT171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04142238OtherHCBS BILLING NUMBER