1528420940 NPI number — COLORADO ASSISTED LIVING HOMES LAMAR

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 1528420940 NPI number — COLORADO ASSISTED LIVING HOMES LAMAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO ASSISTED LIVING HOMES LAMAR
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:
1528420940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2016
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 # 220-1
Provider Second Line Business Mailing Address:
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:
303-948-0555
Provider Business Mailing Address Fax Number:
720-981-0233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6952 S. LAMAR ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-904-2506
Provider Business Practice Location Address Fax Number:
720-981-0233
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PALIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
303-549-1615

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  23M595 , 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: 73970051 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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