Healthcare Provider Details

I. General information

NPI: 1124260450
Provider Name (Legal Business Name): COLORADO SPIRIT ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 E. BETHANY DR.
AUZORA CO
80014
US

IV. Provider business mailing address

10610 E. BETHANY DR.
AUZORA CO
80014
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-3344
  • Fax: 303-745-1409
Mailing address:
  • Phone: 303-745-3344
  • Fax: 303-745-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DILRABO ASIMOVA
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-745-3344