MEDICARE: PARK HILL RESIDENCE 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	AL-1039	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	:	1972712792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK HILL RESIDENCE INC

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	:	1901 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1252
Country	:	US
Telephone Number	:	303-388-9437
Fax Number	:	303-370-1063

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MIKE HOLBROOK
Credential	:
Telephone Number	:	303-595-4464

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/23/2024

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Directions to “PARK HILL RESIDENCE INC ” Practice Location

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