Provider Demographics
NPI:1427595537
Name:TBI COLORADO
Entity type:Organization
Organization Name:TBI COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-412-5730
Mailing Address - Street 1:10706 FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7639
Mailing Address - Country:US
Mailing Address - Phone:720-412-5730
Mailing Address - Fax:303-997-4654
Practice Address - Street 1:10706 FLAGLER DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7639
Practice Address - Country:US
Practice Address - Phone:720-412-5730
Practice Address - Fax:303-997-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23L106310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility