Provider Demographics
NPI:1811664337
Name:EHC21 LLC
Entity type:Organization
Organization Name:EHC21 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADON
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:866-253-9266
Mailing Address - Street 1:1751 HOVER ST # 66B4
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7181
Mailing Address - Country:US
Mailing Address - Phone:469-237-5075
Mailing Address - Fax:
Practice Address - Street 1:1751 HOVER ST # 66B4
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7181
Practice Address - Country:US
Practice Address - Phone:469-237-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service