Provider Demographics
NPI:1285095679
Name:COLORADO ASSISTED LIVING HOMES INGALLS
Entity type:Organization
Organization Name:COLORADO ASSISTED LIVING HOMES INGALLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-549-1615
Mailing Address - Street 1:6638 W OTTAWA AVE # 220-1
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4562
Mailing Address - Country:US
Mailing Address - Phone:303-948-0555
Mailing Address - Fax:720-981-0233
Practice Address - Street 1:7168 S INGALLS WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4653
Practice Address - Country:US
Practice Address - Phone:303-979-0217
Practice Address - Fax:720-981-0233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO ASSISTED LIVING MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304R2310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73970051Medicaid