Provider Demographics
NPI:1124091020
Name:MONACO ADULT DAY CARE
Entity type:Organization
Organization Name:MONACO ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYZENZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-333-2299
Mailing Address - Street 1:6825 E TENNESSEE AVE
Mailing Address - Street 2:# 175
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1628
Mailing Address - Country:US
Mailing Address - Phone:303-333-2299
Mailing Address - Fax:303-388-3119
Practice Address - Street 1:6825 E TENNESSEE AVE
Practice Address - Street 2:# 175
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1628
Practice Address - Country:US
Practice Address - Phone:303-333-2299
Practice Address - Fax:303-388-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72656531Medicaid