Healthcare Provider Details

I. General information

NPI: 1790904092
Provider Name (Legal Business Name): PARENT CARE LIFE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E BUENA VENTURA ST
COLORADO SPRINGS CO
80909-2825
US

IV. Provider business mailing address

1409 E BUENA VENTURA ST
COLORADO SPRINGS CO
80909-2824
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-6339
  • Fax: 719-488-9301
Mailing address:
  • Phone: 719-473-6339
  • Fax: 719-488-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL-0311
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL-0310
License Number StateCO

VIII. Authorized Official

Name: MR. RICKY LEE SIMPSON
Title or Position: OWNER
Credential:
Phone: 719-473-6339