Healthcare Provider Details

I. General information

NPI: 1619912037
Provider Name (Legal Business Name): HOSPICE OF SAINT JOHN FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 EVERETT CT
LAKEWOOD CO
80215-4830
US

IV. Provider business mailing address

1320 EVERETT CT
LAKEWOOD CO
80215-4830
US

V. Phone/Fax

Practice location:
  • Phone: 303-232-7900
  • Fax: 303-232-3614
Mailing address:
  • Phone: 303-232-7900
  • Fax: 303-232-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0739
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number170490
License Number StateCO

VIII. Authorized Official

Name: MR. JERRY HUSON
Title or Position: VP FINANCE/CFO
Credential: CPA
Phone: 303-232-7900