MEDICARE: A CHANGE OF SEASONS ASSISTED LIVING, 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	:	1629961594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CHANGE OF SEASONS ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	225 MARSHALL ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1755
Country	:	US
Telephone Number	:	303-525-4015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 N COOK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3739
Country	:	US
Telephone Number	:	303-525-4015
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ADELE VIGIL
Credential	:
Telephone Number	:	303-525-4015

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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