Provider Demographics
NPI:1528891934
Name:WIICARE COLORADO LLC
Entity type:Organization
Organization Name:WIICARE COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAWAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-469-0044
Mailing Address - Street 1:1501 W EMERALD KEY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6114
Mailing Address - Country:US
Mailing Address - Phone:482-452-9149
Mailing Address - Fax:
Practice Address - Street 1:1642 S PARKER RD STE 307
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2917
Practice Address - Country:US
Practice Address - Phone:480-452-9149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2887-BHE001OtherCOLORADO BEHAVIORAL HEALTH ADMINISTRATION