NPIMap

Organization Active NPI

Sample Supports, LLC

  • Day Training/Habilitation Specialist
  • Longmont, CO
National Provider Identifier
1841964608
Registry record updated Aug 5, 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
380 Main St Ste 200
Longmont, CO 80501-5554
Phone
(720) 684-6102
NPI assigned
Aug 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

380 Main St Ste 200
Longmont, CO 80501-5554

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.

Locations

380 Main St
Ste 200
Longmont, CO 80501

NPI Registry JSON

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1841964608",
    "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": "380 MAIN ST STE 200",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015554",
            "telephone_number": "720-684-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPLE SUPPORTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "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": "380 Main St Ste 200",
            "city": "Longmont",
            "state": "CO",
            "country_code": "US",
            "postal_code": "805015554",
            "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 5, 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.