Healthcare Provider Details

I. General information

NPI: 1881716199
Provider Name (Legal Business Name): CARMEL COMMUNITY LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9299 EASTMAN PARK DR
WINDSOR CO
80550-3318
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-660-1919
  • Fax: 720-600-5176
Mailing address:
  • Phone: 800-804-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04B477
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number04B477
License Number StateCO

VIII. Authorized Official

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