MEDICARE: ACTIVE HEARTS ADULT DAY PROGRAM, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1265843676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE HEARTS ADULT DAY PROGRAM, LLC

Provider Business Mailing Address
First Line	:	3000 S WADSWORTH BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80227-3414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S WADSWORTH BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80227-3414
Country	:	US
Telephone Number	:	720-477-1717
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	OLGA SHAPOVALOVA
Credential	:
Telephone Number	:	720-477-1717

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/20/2014

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