Provider Demographics
NPI:1720484108
Name:BRENT ELEY FOUNDATION
Entity Type:Organization
Organization Name:BRENT ELEY FOUNDATION
Other - Org Name:BRENT'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-343-2802
Mailing Address - Street 1:11980 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-2704
Mailing Address - Country:US
Mailing Address - Phone:720-343-2802
Mailing Address - Fax:
Practice Address - Street 1:11980 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2704
Practice Address - Country:US
Practice Address - Phone:720-343-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)