Healthcare Provider Details

I. General information

NPI: 1043758527
Provider Name (Legal Business Name): SENIORS' RESOURCE CENTER, INC. EVERGREEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 HIGHWAY 73
EVERGREEN CO
80439-7301
US

IV. Provider business mailing address

3227 CHASE ST
WHEAT RIDGE CO
80212-7033
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-2843
  • Fax: 303-674-8874
Mailing address:
  • Phone: 303-238-8151
  • Fax: 303-238-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04G940
License Number StateCO

VIII. Authorized Official

Name: JOHN ZABAWA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 303-238-8151