Basic Information
Provider Information | |||||||||
NPI: | 1174760805 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ARVADA HEALTHCARE, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ARVADA CARE AND REHABILITATION CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6121 W 60TH AVE | ||||||||
Address2: |   | ||||||||
City: | ARVADA | ||||||||
State: | CO | ||||||||
PostalCode: | 800035603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3034204550 | ||||||||
FaxNumber: | 3034243762 | ||||||||
Practice Location | |||||||||
Address1: | 6121 W 60TH AVE | ||||||||
Address2: |   | ||||||||
City: | ARVADA | ||||||||
State: | CO | ||||||||
PostalCode: | 800035603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3034204550 | ||||||||
FaxNumber: | 3034243762 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/16/2009 | ||||||||
LastUpdateDate: | 02/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BURNAM | ||||||||
AuthorizedOfficialFirstName: | SOON | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED AGENT | ||||||||
AuthorizedOfficialTelephone: | 9495401249 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   | CO | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.