MEDICARE: BROOKDALE PLACE OF COLORADO SPRINGS, 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	:	1629766217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKDALE PLACE OF COLORADO SPRINGS, LLC

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST STE 2300
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-5650
Country	:	US
Telephone Number	:	414-918-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 W MONUMENT ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3216
Country	:	US
Telephone Number	:	719-635-6300
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	JOANNE LESKOWICZ
Credential	:
Telephone Number	:	414-918-5000

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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