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General NPI Number Information
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NPI Number | 1720936164
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Entity Type | Organization
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Legal Business Name | TERRY LAKE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 3629 WOODRIDGE RD
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City | FORT COLLINS
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State | CO
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Zip | 80524-1664
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Country | US
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Telephone | 970-313-0896
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Fax | 970-313-0896
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Provider Business Mailing Address
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Address Line | 709 KEENESBURG CT
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City | FORT COLLINS
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State | CO
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Zip | 80525-8270
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Country | US
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Telephone | 970-313-0896
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Fax | 970-313-0896
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Authorized Official
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Title or Position | OWNER/OPERATOR/ADMINISTRATOR
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Name | CHRISTOPHER ERIC SHENK
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Credential | MD
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Telephone | 970-779-1759
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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 |
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