Healthcare Provider Details

I. General information

NPI: 1801302898
Provider Name (Legal Business Name): GOLDEN MANOR OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 W COLFAX AVE
DENVER CO
80204-1121
US

IV. Provider business mailing address

2828 N SPEER BLVD UNIT 240
DENVER CO
80211-4236
US

V. Phone/Fax

Practice location:
  • Phone: 303-893-0600
  • Fax:
Mailing address:
  • Phone: 303-929-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number230488
License Number StateCO

VIII. Authorized Official

Name: BENJAMIN HROUDA
Title or Position: MANAGING PARTNER
Credential:
Phone: 303-929-9955