Provider Demographics
NPI:1114403011
Name:GENTLE HEARTS 3 LLC
Entity Type:Organization
Organization Name:GENTLE HEARTS 3 LLC
Other - Org Name:GENTLE HEARTS 3 ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-931-9032
Mailing Address - Street 1:7741 E EASTER PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7741 E EASTER PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1735
Practice Address - Country:US
Practice Address - Phone:303-931-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid