NPIMap

Organization Active NPI

Sample Supports, LLC

  • Day Training/Habilitation Specialist
  • Longmont, CO
National Provider Identifier
1639843410
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Day Training/Habilitation SpecialistTaxonomy code 373H00000X
Legal business name
SAMPLE SUPPORTS, LLC
Practice address
309 Atwood St
Longmont, CO 80501
Phone
(720) 684-6102
NPI assigned
Aug 4, 2021
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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 Specialist 373H00000X NU Primary

Addresses

Primary practice location

309 Atwood St
Longmont, CO 80501

Mailing address

620 Kimbark St
Longmont, CO 80501-4911
Phone (720) 684-6102

Other identifiers 1

IdentifierTypeStateIssuer
40078256MedicaidCO

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": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1639843410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 KIMBARK ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805014911",
            "telephone_number": "720-684-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 ATWOOD ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "80501",
            "telephone_number": "720-684-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPLE SUPPORTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-07-12",
        "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": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40078256",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carmen@samplesupports.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "309 Atwood St",
            "city": "Longmont",
            "state": "CO",
            "country_code": "US",
            "postal_code": "80501",
            "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 Aug 4, 2021; 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.