Provider Demographics
NPI:1043701337
Name:CENTER AT CENTERPLACE, LLC
Entity Type:Organization
Organization Name:CENTER AT CENTERPLACE, LLC
Other - Org Name:THE CENTER AT CENTERPLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-522-2000
Mailing Address - Street 1:3490 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4087
Mailing Address - Country:US
Mailing Address - Phone:719-685-8951
Mailing Address - Fax:719-685-8958
Practice Address - Street 1:4356 24TH STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3330
Practice Address - Country:US
Practice Address - Phone:719-685-8951
Practice Address - Fax:719-685-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility