Organization
SAMPLE SUPPORTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN LOUISE SAMPLE (CEO)
(303) 523-8057
Entity
Organization
Contact information
Practice address
1236 E ELIZABETH ST, FORT COLLINS, CO 80524-4000
(720) 684-6102
Mailing address
606 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-2779
(720) 684-6102
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000201419
—
CO
Enumeration date
07/12/2021
Last updated
01/31/2023
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