=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790595460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKEWOOD CV OPERATIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12791 W ALAMEDA PKWY
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80228-2838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-237-5700
-----------------------------------------------------
Fax | 323-902-6000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12791 W ALAMEDA PKWY
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80228-2838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-237-5700
-----------------------------------------------------
Fax | 323-902-6000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | STEVEN ATLAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-475-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------