MEDICARE: PARENT CARE LIFE INC

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	310400000X	Assisted Living Facility	230543	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90000143353	OTHER	CO	HCPF PROVIDER ID

General Provider Information

NPI Number	:	1205367414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARENT CARE LIFE INC

Provider Business Mailing Address
First Line	:	1414 N HANCOCK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2655
Country	:	US
Telephone Number	:	719-473-6339
Fax Number	:	719-448-9301

Provider Business Practice Location Address
First Line	:	1209 E CARAMILLO ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2857
Country	:	US
Telephone Number	:	719-473-6339
Fax Number	:	719-448-9301

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RICKY LEE SIMPSON
Credential	:
Telephone Number	:	719-473-6339

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	08/30/2022

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Directions to “PARENT CARE LIFE INC ” Practice Location

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