MEDICARE: BELLAIRE HOUSE ASSISGTED LIVING

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	23N608	CO

General Provider Information

NPI Number	:	1639603376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAIRE HOUSE ASSISGTED LIVING

Provider Business Mailing Address
First Line	:	4301 MARTIN LUTHER KING BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-1826
Country	:	US
Telephone Number	:	303-321-7692
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 MARTIN LUTHER KING BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-1826
Country	:	US
Telephone Number	:	303-321-7692
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIMBERLY BAIYEE-CADY
Credential	:
Telephone Number	:	303-321-7692

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	04/19/2017

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