1881659332 NPI number — SENIOR LIVING OF LAKEWOOD, LLC

Table of content: (NPI 1881659332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881659332 NPI number — SENIOR LIVING OF LAKEWOOD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR LIVING OF LAKEWOOD, LLC
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:
BRIGHTON GARDENS OF LAKEWOOD
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:
1881659332
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:
7900 WESTPARK DR
Provider Second Line Business Mailing Address:
T-900 ATTN: MEDICARE BILLING, M. GARCIA
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102-4242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-854-0823
Provider Business Mailing Address Fax Number:
703-854-0164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12791 W ALAMEDA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-237-5700
Provider Business Practice Location Address Fax Number:
303-237-5850
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARD
Authorized Official First Name:
JUNE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
303-237-5700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0878 , 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)





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