Healthcare Provider Details

I. General information

NPI: 1568007771
Provider Name (Legal Business Name): CARMEL COMMUNITY LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S POTOMAC ST STE 126
AURORA CO
80012-4526
US

IV. Provider business mailing address

451 21ST AVE STE B
LONGMONT CO
80501-1483
US

V. Phone/Fax

Practice location:
  • Phone: 720-296-2605
  • Fax:
Mailing address:
  • Phone: 303-444-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ORDWAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 720-660-1844