Provider Demographics
NPI:1528532314
Name:HARRIS, ROSA L
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4733
Mailing Address - Country:US
Mailing Address - Phone:720-979-6040
Mailing Address - Fax:720-324-4923
Practice Address - Street 1:1423 S EVANSTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4733
Practice Address - Country:US
Practice Address - Phone:720-979-6040
Practice Address - Fax:720-324-4923
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle