1972625283 NPI number — CARMEL COMMUNITY LIVING CORPORATION

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 1972625283 NPI number — CARMEL COMMUNITY LIVING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARMEL COMMUNITY LIVING CORPORATION
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:
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:
1972625283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 21ST AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-1483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-444-0573
Provider Business Mailing Address Fax Number:
720-600-5176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 S POTOMAC ST STE 126
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-804-4511
Provider Business Practice Location Address Fax Number:
720-458-1665
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORDWAY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
720-660-1844

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 37728385 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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