Provider Demographics
NPI:1871255638
Name:GARRETT, MANDI
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 W 26TH AVENUE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:720-629-1849
Mailing Address - Fax:
Practice Address - Street 1:10090 W 26TH AVENUE, SUITE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:720-629-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X, 332U00000X, 342000000X, 343800000X, 343900000X, 146D00000X, 221700000X, 251B00000X, 225800000X, 225A00000X, 372500000X, 372600000X, 253Z00000X
COIMAUDI347C00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No172A00000XOther Service ProvidersDriver
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No251B00000XAgenciesCase Management
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion