=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679706394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEADOW VISTA ASSISTED LIVING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2009
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 E DARTMOUTH AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-6619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-756-6589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2046 ASHWOOD PL
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80129-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-320-7719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SANJAY ARYAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-320-7719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 2304A3
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------