Basic Information
| Provider Information | |||||||||
| NPI: | 1841372638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERITA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6912 S QUENTIN ST STE 50 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202825411 | ||||||||
| FaxNumber: | 8773025251 | ||||||||
| Practice Location | |||||||||
| Address1: | 10204 WERCH DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | WOODRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732299300 | ||||||||
| FaxNumber: | 7732299395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | IRIYE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034070655 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 3336C0004X | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | 054008189 | IL | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
No ID Information.