Provider Demographics
NPI:1972200459
Name:GERAS LLC
Entity type:Organization
Organization Name:GERAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-795-2211
Mailing Address - Street 1:6000 E EVANS AVE STE 3-320
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5441
Mailing Address - Country:US
Mailing Address - Phone:720-230-3363
Mailing Address - Fax:
Practice Address - Street 1:6000 E EVANS AVE STE 3-320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5441
Practice Address - Country:US
Practice Address - Phone:720-230-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04C869OtherCOLORADO HOME HEALTHCARE LICENSE