Basic Information
| Provider Information | |||||||||
| NPI: | 1265500631 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOTAL LONG TERM CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 755 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802205368 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3551 CHAMBERS RD | ||||||||
| Address2: | SUITES A-D | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800111330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033750649 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ORR | ||||||||
| AuthorizedOfficialFirstName: | WILLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3038940144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 363LG0600X | CO | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.