Healthcare Provider Details

I. General information

NPI: 1881830966
Provider Name (Legal Business Name): JOHNSON ADULT DAY PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 S EMERSON ST
ENGLEWOOD CO
80113-2834
US

IV. Provider business mailing address

200 E 9TH AVE
DENVER CO
80203-2903
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-1519
  • Fax: 303-789-7642
Mailing address:
  • Phone: 303-869-4664
  • Fax: 303-869-2917

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: MR. JOHN B. IRONS JR.
Title or Position: TREASURER
Credential:
Phone: 720-974-6784