Basic Information
Provider Information
NPI: 1396700225
EntityType: 2
ReplacementNPI:  
OrganizationName: SENIOR LIVING OF COLORADO SPRINGS, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BRIGHTON GARDENS OF COLORADO SPRINGS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7900 WESTPARK DR. ST T-900
Address2: ATTN: MEDICARE BILLING, M. GARCIA
City: MCLEAN
State: VA
PostalCode: 221024242
CountryCode: US
TelephoneNumber: 7038540823
FaxNumber: 7038540164
Practice Location
Address1: 1685 S 21ST ST
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809044273
CountryCode: US
TelephoneNumber: 7193291774
FaxNumber: 7193291695
Other Information
ProviderEnumerationDate: 04/20/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LACHANCE
AuthorizedOfficialFirstName: DEAN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 7193291774
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X0776COY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


Home