Healthcare Provider Details

I. General information

NPI: 1205594355
Provider Name (Legal Business Name): GREELEY ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 29TH AVENUE PL
GREELEY CO
80634-6822
US

IV. Provider business mailing address

1663 29TH AVENUE PL
GREELEY CO
80634-6822
US

V. Phone/Fax

Practice location:
  • Phone: 970-336-9063
  • Fax: 970-336-9110
Mailing address:
  • Phone: 970-336-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT TOD MURRAY
Title or Position: COO
Credential:
Phone: 480-599-3459