Healthcare Provider Details

I. General information

NPI: 1962368118
Provider Name (Legal Business Name): 1 MILE HIGH SENIOR CLUB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 LEETSDALE DR UNIT H
DENVER CO
80224-1576
US

IV. Provider business mailing address

6603 LEETSDALE DR UNIT H
DENVER CO
80224-1576
US

V. Phone/Fax

Practice location:
  • Phone: 303-457-4000
  • Fax:
Mailing address:
  • Phone: 303-457-4000
  • Fax:

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: ZINEB BOUAYAD
Title or Position: OWNER
Credential:
Phone: 720-938-0470