Healthcare Provider Details

I. General information

NPI: 1265074181
Provider Name (Legal Business Name): GENDENVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S ROSLYN ST
DENVER CO
80231-3745
US

IV. Provider business mailing address

8440 SE SUNNYBROOK BLVD STE 100
CLACKAMAS OR
97015-5781
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-0750
  • Fax:
Mailing address:
  • Phone: 503-652-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA STAYNER
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 503-594-2263