Healthcare Provider Details

I. General information

NPI: 1831604016
Provider Name (Legal Business Name): LIFE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2017
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S POTOMAC WAY STE 116
AURORA CO
80012-1375
US

IV. Provider business mailing address

1390 S POTOMAC ST STE 116
AURORA CO
80012-4529
US

V. Phone/Fax

Practice location:
  • Phone: 720-989-0651
  • Fax:
Mailing address:
  • Phone: 720-989-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCO

VIII. Authorized Official

Name: DURGA TAMANG
Title or Position: COORDINATOR
Credential:
Phone: 720-989-0651