Provider Demographics
NPI:1992998363
Name:BOULDER COUNTY ENTERPRISES INC
Entity type:Organization
Organization Name:BOULDER COUNTY ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-266-2789
Mailing Address - Street 1:6290 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3319
Mailing Address - Country:US
Mailing Address - Phone:720-266-2789
Mailing Address - Fax:303-527-0628
Practice Address - Street 1:6290 LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3319
Practice Address - Country:US
Practice Address - Phone:303-266-2789
Practice Address - Fax:303-527-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09143405Medicaid