Healthcare Provider Details

I. General information

NPI: 1023981644
Provider Name (Legal Business Name): 5905 S MILWAUKEE WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 S MILWAUKEE WAY
CENTENNIAL CO
80121-2831
US

IV. Provider business mailing address

6143 S WILLOW DR STE 401
GREENWOOD VILLAGE CO
80111-5125
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-6886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC LEWIS
Title or Position: CEO
Credential:
Phone: 303-996-6886