Healthcare Provider Details

I. General information

NPI: 1154443851
Provider Name (Legal Business Name): TRG MANAGEMENT CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 VANCE ST
LAKEWOOD CO
80214-4281
US

IV. Provider business mailing address

1325 VANCE ST
LAKEWOOD CO
80214-4281
US

V. Phone/Fax

Practice location:
  • Phone: 303-274-4400
  • Fax: 303-274-4065
Mailing address:
  • Phone: 303-274-4400
  • Fax: 303-274-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-0339
License Number StateCO

VIII. Authorized Official

Name: MRS. KATHY DIANE BROCK
Title or Position: BOOKKEEPER
Credential:
Phone: 303-274-4400