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General NPI Number Information
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NPI Number | 1871309914
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Entity Type | Organization
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Legal Business Name | ICARE ASSISTED LIVING FACILITY-ULSTER LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 7208 S ULSTER ST
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City | CENTENNIAL
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State | CO
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Zip | 80112-1821
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Country | US
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Telephone | 720-313-6385
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Fax |
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Provider Business Mailing Address
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Address Line | 7208 S ULSTER ST
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City | CENTENNIAL
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State | CO
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Zip | 80112-1821
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Country | US
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Telephone | 720-313-6385
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | FAHRREN BOLASTIG
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Credential |
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Telephone | 720-313-6385
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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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