Provider Demographics
NPI:1316497100
Name:GOLDEN ORCHARD III
Entity type:Organization
Organization Name:GOLDEN ORCHARD III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FEROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-619-7837
Mailing Address - Street 1:2322 BEACHAM DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2355
Mailing Address - Country:US
Mailing Address - Phone:303-660-1437
Mailing Address - Fax:303-660-5143
Practice Address - Street 1:2322 BEACHAM DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2355
Practice Address - Country:US
Practice Address - Phone:303-660-1437
Practice Address - Fax:303-660-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304U9310400000X
CO2304YQ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility