Provider Demographics
NPI:1104286376
Name:COLORADO ASSISTED LIVING HOMES
Entity type:Organization
Organization Name:COLORADO ASSISTED LIVING HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIMONAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-324-0834
Mailing Address - Street 1:6638 W OTTAWA AVE
Mailing Address - Street 2:SUITE 150-1
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4562
Mailing Address - Country:US
Mailing Address - Phone:303-324-0834
Mailing Address - Fax:303-948-0570
Practice Address - Street 1:7456 S KENDALL BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4682
Practice Address - Country:US
Practice Address - Phone:303-324-0834
Practice Address - Fax:303-948-0570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO ASSISTED LIVING HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-02
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304JT305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14902338Medicaid