Provider Demographics
NPI:1427677194
Name:MELIORA DIRECT HEALTH LLC
Entity type:Organization
Organization Name:MELIORA DIRECT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-317-9460
Mailing Address - Street 1:488 PAWLING AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5832
Mailing Address - Country:US
Mailing Address - Phone:720-317-9460
Mailing Address - Fax:877-268-5001
Practice Address - Street 1:10290 S PROGRESS WAY STE 208
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9056
Practice Address - Country:US
Practice Address - Phone:303-317-3088
Practice Address - Fax:877-268-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO573324Medicaid
MR0979952OtherDEA