Provider Demographics
NPI:1316319551
Name:BROTHERS AIRPORT EXPRESS LLC
Entity type:Organization
Organization Name:BROTHERS AIRPORT EXPRESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEMSEGED
Authorized Official - Middle Name:YIFRU
Authorized Official - Last Name:YEMANEH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:720-206-8501
Mailing Address - Street 1:1339 QUARI ST APT 222
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6239
Mailing Address - Country:US
Mailing Address - Phone:720-206-8501
Mailing Address - Fax:
Practice Address - Street 1:1339 QUARI ST APT 222
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6239
Practice Address - Country:US
Practice Address - Phone:720-206-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLL-01953343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81758260Medicaid