=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982799383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANLON-BUSH INVESTMENTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 PATTON STREET
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-484-7981
-----------------------------------------------------
Fax | 970-484-8103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 PATTON ST
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-484-7981
-----------------------------------------------------
Fax | 970-484-8143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ANTHONY JOHN HANLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-484-7981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 1246
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1246
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------