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General NPI Number Information
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NPI Number | 1235714684
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Entity Type | Organization
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Legal Business Name | LIVEWELLCOLORADO ADS I LLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 1200 S. ABILENE STREET UNIT C
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City | AURORA
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State | CO
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Zip | 80012-4629
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Country | US
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Telephone | 888-716-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 6760 E GEDDES LN ATTENTION: RICHARD GIANCOLA
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City | CENTENNIAL
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State | CO
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Zip | 80112-1573
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Country | US
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Telephone | 303-478-8115
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOHN A BERSANI
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Credential |
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Telephone | 617-974-2279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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