Healthcare Provider Details

I. General information

NPI: 1902803620
Provider Name (Legal Business Name): 33 SOUTHMOOR PROPERTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FENTON ST
WHEAT RIDGE CO
80214-8116
US

IV. Provider business mailing address

2920 FENTON ST
WHEAT RIDGE CO
80214-8116
US

V. Phone/Fax

Practice location:
  • Phone: 303-238-0481
  • Fax: 303-233-3775
Mailing address:
  • Phone: 303-238-0481
  • Fax: 303-233-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020436
License Number StateCO

VIII. Authorized Official

Name: MR. JAY H. MOSKOWITZ
Title or Position: CEO
Credential: NHA
Phone: 303-238-3838