Provider Demographics
NPI:1386363745
Name:FOUNDATION FOR SUCCESSFUL LIVING, INC
Entity type:Organization
Organization Name:FOUNDATION FOR SUCCESSFUL LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-227-3939
Mailing Address - Street 1:1879 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7857
Mailing Address - Country:US
Mailing Address - Phone:719-216-6482
Mailing Address - Fax:
Practice Address - Street 1:8200 E. PACIFIC PLACE STE 104
Practice Address - Street 2:
Practice Address - City:DENVER,
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:719-227-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATION FOR SUCCESSFUL LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child