MEDICARE: DESHANO CARE CENTERS 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	2304KB	CO

General Provider Information

NPI Number	:	1932681335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESHANO CARE CENTERS LLC

Provider Business Mailing Address
First Line	:	355 S TELLER ST STE 200
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-7391
Country	:	US
Telephone Number	:	303-803-6977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 S REED CT
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5216
Country	:	US
Telephone Number	:	303-803-6977
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUKONTAR DESHANO
Credential	:
Telephone Number	:	303-803-6977

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	12/02/2025

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