Healthcare Provider Details

I. General information

NPI: 1669158259
Provider Name (Legal Business Name): HEATHER GROVE ASSISTED LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 GROVE ST
DENVER CO
80211-3286
US

IV. Provider business mailing address

3289 GROVE ST
DENVER CO
80211-3286
US

V. Phone/Fax

Practice location:
  • Phone: 303-477-4262
  • Fax: 303-477-0720
Mailing address:
  • Phone: 303-477-4262
  • Fax: 303-477-0720

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: MR. JEFFREY S SUPIT
Title or Position: MANAGER
Credential:
Phone: 303-993-6265