1104286376 NPI number — COLORADO ASSISTED LIVING HOMES

Table of content: MRS. JAIME LYN MANN MS, ATC, LAT, CES (NPI 1720224777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104286376 NPI number — COLORADO ASSISTED LIVING HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO ASSISTED LIVING HOMES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104286376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6638 W OTTAWA AVE
Provider Second Line Business Mailing Address:
SUITE 150-1
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80128-4562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-324-0834
Provider Business Mailing Address Fax Number:
303-948-0570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7456 S KENDALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80128-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-324-0834
Provider Business Practice Location Address Fax Number:
303-948-0570
Provider Enumeration Date:
03/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONAITIS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-324-0834

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  2304JT , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14902338 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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