Provider Demographics
NPI:1386716215
Name:COLORADO SPRINGS SENIOR HOMES, INC.
Entity type:Organization
Organization Name:COLORADO SPRINGS SENIOR HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-636-2731
Mailing Address - Street 1:3031 N EL PASO ST
Mailing Address - Street 2:P.O. BOX 7067
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5412
Mailing Address - Country:US
Mailing Address - Phone:719-636-2731
Mailing Address - Fax:719-636-2010
Practice Address - Street 1:3102-3108 NORTH PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-636-2731
Practice Address - Fax:719-636-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230518310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0418061Medicaid