Healthcare Provider Details

I. General information

NPI: 1225417512
Provider Name (Legal Business Name): ALPINE ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 S HAVANA ST
AURORA CO
80014-1011
US

IV. Provider business mailing address

1985 S HAVANA ST
AURORA CO
80014-1011
US

V. Phone/Fax

Practice location:
  • Phone: 303-755-8002
  • Fax: 303-755-8003
Mailing address:
  • Phone: 303-755-8002
  • Fax: 303-755-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number169342
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberB-09977
License Number StateCO

VIII. Authorized Official

Name: MR. ALIK A KASSNER
Title or Position: PARTNER
Credential:
Phone: 303-601-3538