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General NPI Number Information
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NPI Number | 1144749466
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Entity Type | Organization
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Legal Business Name | EXTENDED FAMILY ASSISTED LIVING INC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 7488 S KIT CARSON ST
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City | CENTENNIAL
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State | CO
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Zip | 80122-1495
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Country | US
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Telephone | 720-283-2127
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Fax | 720-283-2128
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Provider Business Mailing Address
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Address Line | 19160 E PACIFIC PL
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City | AURORA
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State | CO
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Zip | 80013-7769
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Country | US
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Telephone | 720-670-6293
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Fax | 720-283-2128
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. YELLI MONINGKA
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Credential |
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Telephone | 720-670-6293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | CO
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