1972727758 NPI number — SERENITY HOUSE ASSISTED LIVING, INC

Table of content: (NPI 1972727758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972727758 NPI number — SERENITY HOUSE ASSISTED LIVING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY HOUSE ASSISTED LIVING, 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:
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:
1972727758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5290 E YALE CIR STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-6933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-584-8926
Provider Business Mailing Address Fax Number:
303-584-9508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5290 E YALE CIR STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-6933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-584-8926
Provider Business Practice Location Address Fax Number:
303-584-9508
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZISLIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
WARREN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-584-8926

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL-0378 , 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: 42377820 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50536788 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57787069 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63581582 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76539873 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09478876 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20728352 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59384735 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18202586 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53278771 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99189542 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50053230 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33037027 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78981824 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95529284 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97354520 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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