Provider Demographics
NPI:1114190147
Name:EASTERN SLOPE HOUSING
Entity Type:Organization
Organization Name:EASTERN SLOPE HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-622-6262
Mailing Address - Street 1:56175 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136-7843
Mailing Address - Country:US
Mailing Address - Phone:303-622-6262
Mailing Address - Fax:303-622-6263
Practice Address - Street 1:56175 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136-7843
Practice Address - Country:US
Practice Address - Phone:303-622-6262
Practice Address - Fax:303-622-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230410310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04182481Medicaid