=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639177801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANIMAS EQUITY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 10/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 E 3RD AVE
-----------------------------------------------------
City | MANCOS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81328-9079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-533-9031
-----------------------------------------------------
Fax | 970-533-7297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E 3RD AVE
-----------------------------------------------------
City | MANCOS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81328-9079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-533-9031
-----------------------------------------------------
Fax | 970-533-7297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGEMENT
-----------------------------------------------------
Name | MS. KELLI L LIKES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-516-1404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0158
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------