1104286376 NPI number — COLORADO ASSISTED LIVING HOMES

Table of content: (NPI 1104286376)

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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