Healthcare Provider Details

I. General information

NPI: 1346755600
Provider Name (Legal Business Name): CARMEL COMMUNITY LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BOSTON AVE
LONGMONT CO
80501-5882
US

IV. Provider business mailing address

11177 W 8TH AVE
LAKEWOOD CO
80215-5575
US

V. Phone/Fax

Practice location:
  • Phone: 720-496-2605
  • Fax: 720-458-1665
Mailing address:
  • Phone: 720-796-2605
  • Fax: 720-458-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ORDWAY
Title or Position: CHIEF DEVELOPMENT OFFICER
Credential: MS
Phone: 720-496-2605