Provider Demographics
NPI:1144749466
Name:EXTENDED FAMILY ASSISTED LIVING INC
Entity Type:Organization
Organization Name:EXTENDED FAMILY ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MONINGKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-670-6293
Mailing Address - Street 1:19160 E PACIFIC PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7769
Mailing Address - Country:US
Mailing Address - Phone:720-670-6293
Mailing Address - Fax:720-283-2128
Practice Address - Street 1:7488 S KIT CARSON ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1495
Practice Address - Country:US
Practice Address - Phone:720-283-2127
Practice Address - Fax:720-283-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility