=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043765084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SENIOR HUB, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2016
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2360 W 90TH AVE
-----------------------------------------------------
City | FEDERAL HEIGHTS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-287-2400
-----------------------------------------------------
Fax | 303-287-0572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9025 GRANT ST STE 150
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80229-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-426-4408
-----------------------------------------------------
Fax | 303-426-0014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | CALINA CHATELAIN BOWMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 303-426-4408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------