1386716215 NPI number — COLORADO SPRINGS SENIOR HOMES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386716215 NPI number — COLORADO SPRINGS SENIOR HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO SPRINGS SENIOR HOMES, INC.
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:
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:
1386716215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3031 N EL PASO ST
Provider Second Line Business Mailing Address:
P.O. BOX 7067
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-5412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-636-2731
Provider Business Mailing Address Fax Number:
719-636-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3102-3108 NORTH PROSPECT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-636-2731
Provider Business Practice Location Address Fax Number:
719-636-2010
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSEN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-636-2731

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  230518 , 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: 0418061 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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