MEDICARE: SOLANGE AT EVENINGSONG 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1396341939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLANGE AT EVENINGSONG LLC

Provider Business Mailing Address
First Line	:	572 EVENINGSONG DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2903
Country	:	US
Telephone Number	:	719-231-2152
Fax Number	:

Provider Business Practice Location Address
First Line	:	572 EVENINGSONG DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2903
Country	:	US
Telephone Number	:	719-231-2152
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTEL AIME
Credential	:
Telephone Number	:	719-231-2152

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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Directions to “SOLANGE AT EVENINGSONG LLC ” Practice Location

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