MEDICARE: RESIDENTIAL CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	1550166	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1550166	OTHER	CO	GROUP HOME LICENSE

General Provider Information

NPI Number	:	1013193861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL CARE SERVICES

Provider Business Mailing Address
First Line	:	4328 ANDES WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-6582
Country	:	US
Telephone Number	:	720-434-1790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 ANDES WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-6582
Country	:	US
Telephone Number	:	720-434-1790
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS MICHELLE DEON LEE
Credential	:
Telephone Number	:	720-434-1490

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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Directions to “RESIDENTIAL CARE SERVICES ” Practice Location

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