Healthcare Provider Details

I. General information

NPI: 1831149962
Provider Name (Legal Business Name): 656 DILLON WAY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 DILLON WAY
AURORA CO
80011-6803
US

IV. Provider business mailing address

101 E STATE ST REIMBURSEMENT
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-0636
  • Fax: 303-344-0639
Mailing address:
  • Phone: 505-468-4742
  • Fax: 505-468-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0389
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DIVITTORIO
Title or Position: CFO, TREASURER, ASST SECRETARY
Credential:
Phone: 610-444-6350