Provider Demographics
NPI:1588089676
Name:7395 W EASTMAN PLACE OPERATIONS LLC
Entity type:Organization
Organization Name:7395 W EASTMAN PLACE OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:7395 W EASTMAN PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5006
Mailing Address - Country:US
Mailing Address - Phone:720-388-1042
Mailing Address - Fax:720-388-1046
Practice Address - Street 1:7395 W. EASTMAN PLACE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-1234
Practice Address - Country:US
Practice Address - Phone:720-388-1042
Practice Address - Fax:720-388-1046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS CO HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO020853314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility