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General NPI Number Information
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NPI Number | 1417310509
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Entity Type | Organization
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Legal Business Name | IDYLLWOOD MANOR AT ANDES CT., LLC
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 5286 S ANDES CT
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City | CENTENNIAL
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State | CO
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Zip | 80015-4896
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Country | US
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Telephone | 303-513-4784
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Fax | 303-799-5837
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Provider Business Mailing Address
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Address Line | PO BOX 2253
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City | PARKER
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State | CO
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Zip | 80134-1414
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Country | US
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Telephone | 303-513-4784
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Fax | 303-799-5837
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Authorized Official
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Title or Position | MEMBER
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Name | BOB MANZI
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Credential |
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Telephone | 303-513-4784
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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 | 23V725
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License Number State | CO
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