Provider Demographics
NPI:1649721374
Name:DKL VENTURES, LLC
Entity type:Organization
Organization Name:DKL VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-757-2300
Mailing Address - Street 1:6143 S WILLOW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5122
Mailing Address - Country:US
Mailing Address - Phone:303-757-2300
Mailing Address - Fax:303-756-3263
Practice Address - Street 1:6143 S WILLOW DR STE 102
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5122
Practice Address - Country:US
Practice Address - Phone:303-757-2300
Practice Address - Fax:303-756-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04Y381253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39579875Medicaid