Healthcare Provider Details

I. General information

NPI: 1376608505
Provider Name (Legal Business Name): CARMEL COMMUNITY LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S BOWEN ST STE 6
LONGMONT CO
80501-6140
US

IV. Provider business mailing address

451 21ST AVE STE B
LONGMONT CO
80501-1483
US

V. Phone/Fax

Practice location:
  • Phone: 720-660-1844
  • Fax: 720-458-1665
Mailing address:
  • Phone: 303-444-0573
  • Fax: 720-600-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04B477
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04B477
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number04B477
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ORDWAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSC
Phone: 720-660-1844