MEDICARE: PRINCETON HOUSE

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL-0197	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972712701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON HOUSE

Provider Business Mailing Address
First Line	:	1510 17TH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1202
Country	:	US
Telephone Number	:	303-595-4464
Fax Number	:	303-595-9225

Provider Business Practice Location Address
First Line	:	3884 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3111
Country	:	US
Telephone Number	:	303-761-1460
Fax Number	:	303-761-3619

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERI J. WHELAN
Credential	:
Telephone Number	:	303-595-4464

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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Directions to “PRINCETON HOUSE ” Practice Location

Language	Start Address	Practice Location

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