Provider Demographics
NPI:1174339188
Name:SUPPORT FAITH CARE TEAM LLC
Entity type:Organization
Organization Name:SUPPORT FAITH CARE TEAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIRUT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKONNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-229-4341
Mailing Address - Street 1:18810 E VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6471
Mailing Address - Country:US
Mailing Address - Phone:720-229-4341
Mailing Address - Fax:
Practice Address - Street 1:18810 E VASSAR DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6471
Practice Address - Country:US
Practice Address - Phone:720-229-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services