NPIMap

Organization Active NPI

Sample Supports, LLC

  • Day Training/Habilitation Specialist
  • Longmont, CO
National Provider Identifier
1295492387
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Day Training/Habilitation SpecialistTaxonomy code 373H00000X
Legal business name
SAMPLE SUPPORTS, LLC
Practice address
606 Mountain View Ave
Longmont, CO 80501-2779
Phone
(720) 684-6102
NPI assigned
Nov 23, 2021
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carmen Louise SampleNPI 1609104991
Title
Ceo
Phone
(303) 523-8057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Day Training/Habilitation SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 373H00000X Primary

Addresses

Primary practice location

606 Mountain View Ave
Longmont, CO 80501-2779

Mailing address

606 Mountain View Ave
Longmont, CO 80501-2779
Phone (720) 684-6102

Other identifiers 1

IdentifierTypeStateIssuer
9000202105MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address carmen@samplesupports.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Sample Supports LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1295492387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805012779",
            "telephone_number": "720-684-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805012779",
            "telephone_number": "720-684-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPLE SUPPORTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "SAMPLE",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-523-8057"
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000202105",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carmen@samplesupports.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "606 Mountain View Ave",
            "city": "Longmont",
            "state": "CO",
            "country_code": "US",
            "postal_code": "805012779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.