1962865881 NPI number — CASA DE ADULT DAY CARE INC

Table of content: (NPI 1962865881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962865881 NPI number — CASA DE ADULT DAY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASA DE ADULT DAY CARE 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:
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:
1962865881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12500 W 58TH AVE
Provider Second Line Business Mailing Address:
UNIT 103
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80002-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-534-0321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 W 58TH AVE
Provider Second Line Business Practice Location Address:
UNIT 103
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80002-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-534-0321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOPCUS
Authorized Official First Name:
SVETLANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR/OWNER
Authorized Official Telephone Number:
303-534-0321

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56323077 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: B9888 . This is a "PUC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com