Provider Demographics
NPI:1972262566
Name:NEURO14 LLC
Entity type:Organization
Organization Name:NEURO14 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:315-316-1414
Mailing Address - Street 1:1075 E FREMONT CIR S
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:720-844-3314
Practice Address - Street 1:2305 E ARAPAHOE RD STE 250
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1548
Practice Address - Country:US
Practice Address - Phone:315-316-1414
Practice Address - Fax:720-844-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000199004Medicaid