Provider Demographics
NPI:1902342504
Name:BILARD GEBREHIWET
Entity Type:Organization
Organization Name:BILARD GEBREHIWET
Other - Org Name:BILIARD LIMO LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:BILIARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEBREHIWET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-217-2528
Mailing Address - Street 1:22805 E PRENTICE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6550
Mailing Address - Country:US
Mailing Address - Phone:720-217-2528
Mailing Address - Fax:
Practice Address - Street 1:22805 E PRENTICE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6550
Practice Address - Country:US
Practice Address - Phone:720-217-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BILIARD LIMO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)