MEDICARE: MADISON'S GARDENS LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255096160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON'S GARDENS LLC

Provider Business Mailing Address
First Line	:	3260 MONACO PKWY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-2204
Country	:	US
Telephone Number	:	720-226-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 MONACO PKWY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-2204
Country	:	US
Telephone Number	:	720-226-6440
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARIA ROSA AMEZCUA MARTIN
Credential	:
Telephone Number	:	720-226-6440

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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