Provider Demographics
NPI:1104461771
Name:SANDALWOOD MANOR, INC
Entity type:Organization
Organization Name:SANDALWOOD MANOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-1533
Mailing Address - Street 1:1127 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1506
Mailing Address - Country:US
Mailing Address - Phone:303-421-3600
Mailing Address - Fax:
Practice Address - Street 1:3835 HARLAN ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5111
Practice Address - Country:US
Practice Address - Phone:303-421-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05651534Medicaid