1871578039 NPI number — CHRISTIAN LIVING NEIGHBORHOODS

Table of content: (NPI 1871578039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871578039 NPI number — CHRISTIAN LIVING NEIGHBORHOODS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN LIVING NEIGHBORHOODS
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:
CHRISTIAN LIVING COMMUNITIES THE SUITES AT SOMEREN GLEN CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1871578039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9570 S KINGSTON CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-974-3555
Provider Business Mailing Address Fax Number:
720-974-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 E ARAPAHOE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTENNIAL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-779-5000
Provider Business Practice Location Address Fax Number:
303-779-1570
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHILDS
Authorized Official First Name:
BRYON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
720-974-3504

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  0271 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , 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: 37976231 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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