Provider Demographics
NPI:1750791174
Name:BECKETT-GRAVES HEALTH & FAMILY PRACTICE
Entity type:Organization
Organization Name:BECKETT-GRAVES HEALTH & FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS-BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:866-239-5133
Mailing Address - Street 1:PO BOX 202926
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-8926
Mailing Address - Country:US
Mailing Address - Phone:866-239-5133
Mailing Address - Fax:888-384-7012
Practice Address - Street 1:91 NEWARK ST UNIT D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1637
Practice Address - Country:US
Practice Address - Phone:866-239-5133
Practice Address - Fax:888-384-7012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAYPREE ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOTP149399AMedicaid