Provider Demographics
NPI:1194445684
Name:ENRICHED ASSISTED LIVING AT PRINCETON WAY LLC
Entity type:Organization
Organization Name:ENRICHED ASSISTED LIVING AT PRINCETON WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARAN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-331-4125
Mailing Address - Street 1:8120 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2982
Mailing Address - Country:US
Mailing Address - Phone:171-933-1412
Mailing Address - Fax:
Practice Address - Street 1:2107 PRINCETON WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2043
Practice Address - Country:US
Practice Address - Phone:719-331-4125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility