Provider Demographics
NPI:1114203601
Name:PARENT CARE LIFE INC.
Entity Type:Organization
Organization Name:PARENT CARE LIFE INC.
Other - Org Name:MAPLEGROVE EAST AT CRESTVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-6339
Mailing Address - Street 1:1414 N HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2655
Mailing Address - Country:US
Mailing Address - Phone:719-473-6339
Mailing Address - Fax:719-448-9301
Practice Address - Street 1:1417 E BUENA VENTURA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2824
Practice Address - Country:US
Practice Address - Phone:719-473-6339
Practice Address - Fax:719-448-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23G509310400000X, 311Z00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home