Provider Demographics
NPI:1588102578
Name:ALLIES LLC
Entity type:Organization
Organization Name:ALLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVOLL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:303-946-3197
Mailing Address - Street 1:3000 S JAMAICA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4601
Mailing Address - Country:US
Mailing Address - Phone:303-750-5007
Mailing Address - Fax:303-750-5009
Practice Address - Street 1:3000 S JAMAICA CT STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4601
Practice Address - Country:US
Practice Address - Phone:303-750-5007
Practice Address - Fax:303-750-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01637231Medicaid