MEDICARE: NORTHERN COLORADO LIVING SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104447978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN COLORADO LIVING SOLUTIONS

Provider Business Mailing Address
First Line	:	4021 SPRUCE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1059
Country	:	US
Telephone Number	:	970-388-5588
Fax Number	:	970-449-4476

Provider Business Practice Location Address
First Line	:	4021 SPRUCE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1059
Country	:	US
Telephone Number	:	970-388-5588
Fax Number	:	970-449-4476

Authorized Official
Title or Position	:	ADMINISTRRATOR
Name	:	MS. TAMRA M MEURER
Credential	:	NP
Telephone Number	:	970-388-5588

Provider Enumeration Date	:	05/02/2020
Last Update Date	:	05/02/2020

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