Provider Demographics
NPI:1043758527
Name:SENIORS' RESOURCE CENTER, INC. EVERGREEN
Entity Type:Organization
Organization Name:SENIORS' RESOURCE CENTER, INC. EVERGREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-238-8151
Mailing Address - Street 1:3227 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7033
Mailing Address - Country:US
Mailing Address - Phone:303-238-8151
Mailing Address - Fax:303-238-4393
Practice Address - Street 1:5120 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7301
Practice Address - Country:US
Practice Address - Phone:303-674-2843
Practice Address - Fax:303-674-8874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORS' RESOURCE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04G940251E00000X
261QA0600X, 343900000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04138632Medicaid
CO06000764Medicaid