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General NPI Number Information
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NPI Number | 1912444993
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Entity Type | Organization
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Legal Business Name | ST.ANTHONY OF PADUA HOMES, LLC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 3545 LEYDEN ST
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City | DENVER
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State | CO
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Zip | 80207-1343
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Country | US
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Telephone | 303-333-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 14024 PARK COVE DR
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City | BROOMFIELD
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State | CO
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Zip | 80023-6596
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA BOUTROUS
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Credential |
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Telephone | 701-226-0905
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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 | 23O672
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License Number State | CO
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