Provider Demographics
NPI:1063401420
Name:GUNERATNE LLC
Entity type:Organization
Organization Name:GUNERATNE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNERATNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-663-3663
Mailing Address - Street 1:312 WILCOX ST
Mailing Address - Street 2:#204
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2480
Mailing Address - Country:US
Mailing Address - Phone:303-663-3663
Mailing Address - Fax:303-663-8879
Practice Address - Street 1:312 WILCOX ST
Practice Address - Street 2:#204
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2480
Practice Address - Country:US
Practice Address - Phone:303-663-3663
Practice Address - Fax:303-663-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67732739Medicaid
CO841591880OtherUNITED HEALTH CARE #
CO841591880-01OtherPACIFICARE/SECURE HORIZON
CO606739000OtherACS-DEPARTMENT OF LABOR
CO67732739Medicaid