Healthcare Provider Details

I. General information

NPI: 1942261011
Provider Name (Legal Business Name): BURLINGTON ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S 9TH ST
BURLINGTON CO
80807-2071
US

IV. Provider business mailing address

2415 MULLINS AVE SUITE 4
ALAMOSA CO
81101-4274
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-7403
  • Fax: 719-346-5708
Mailing address:
  • Phone: 719-589-2063
  • Fax: 719-589-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-0056
License Number StateCO

VIII. Authorized Official

Name: DONALD KANEN
Title or Position: CFO
Credential:
Phone: 719-589-2063