MEDICARE: A HOME FOR LIFE, INC

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	:	1740823608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A HOME FOR LIFE, INC

Provider Business Mailing Address
First Line	:	1725 LAKEVIEW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1938
Country	:	US
Telephone Number	:	970-218-5057
Fax Number	:	970-444-5645

Provider Business Practice Location Address
First Line	:	1725 LAKEVIEW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1938
Country	:	US
Telephone Number	:	970-218-5057
Fax Number	:	970-444-5645

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	ERIN ELLIS
Credential	:
Telephone Number	:	970-218-5057

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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