Provider Demographics
NPI:1073500450
Name:COLORADO STATE VETERANS HOME AT FITZSIMONS
Entity Type:Organization
Organization Name:COLORADO STATE VETERANS HOME AT FITZSIMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-857-6423
Mailing Address - Street 1:1919 QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-7125
Mailing Address - Country:US
Mailing Address - Phone:720-857-6400
Mailing Address - Fax:720-857-6500
Practice Address - Street 1:1919 QUENTIN ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-7125
Practice Address - Country:US
Practice Address - Phone:720-857-6400
Practice Address - Fax:720-857-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0666314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15088219Medicaid
CO82159815Medicaid
CO82159815Medicaid