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General NPI Number Information
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NPI Number | 1891160560
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Entity Type | Organization
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Legal Business Name | CROSSROADS AT DELTA ALF
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 1380 ASPEN WAY
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City | DELTA
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State | CO
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Zip | 81416-2551
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Country | US
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Telephone | 970-874-1421
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Fax |
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Provider Business Mailing Address
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Address Line | 990 RESERVE DR SUITE 240
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City | ROSEVILLE
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State | CA
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Zip | 95678-1387
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Country | US
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Telephone | 916-774-7700
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Fax | 916-774-7701
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | SUSAN BUSHNELL
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Credential |
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Telephone | 916-774-7700
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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 | 2304MZ
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License Number State | CO
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