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
380 MAIN ST STE 200, LONGMONT, CO 80501-5554
(720) 684-6102
Mailing address
620 KIMBARK ST, LONGMONT, CO 80501-4911
(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
—
40078256
—
CO
Enumeration date
08/05/2021
Last updated
08/05/2021
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