Basic Information
| Provider Information | |||||||||
| NPI: | 1518076462 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC HEALTH INITIATIVES COLORADO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROGRESSIVE CARE CENTER SENIOR DAY PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 S COLORADO BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669050165 | ||||||||
| FaxNumber: | 3037157010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1338 PHAY AVE | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812122302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192692122 | ||||||||
| FaxNumber: | 7192692256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO, SENIOR SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3037157013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | CO | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
ID Information
| ID | Type | State | Issuer | Description | 04143558 | 05 | CO | MEDICAID |