Provider Demographics
NPI:1144945171
Name:LA VETA VILLAGE, INC.
Entity type:Organization
Organization Name:LA VETA VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-742-3510
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:LA VETA
Mailing Address - State:CO
Mailing Address - Zip Code:81055-0143
Mailing Address - Country:US
Mailing Address - Phone:719-742-3510
Mailing Address - Fax:
Practice Address - Street 1:109 E. FRANCISCO ST.
Practice Address - Street 2:
Practice Address - City:LA VETA
Practice Address - State:CO
Practice Address - Zip Code:81055
Practice Address - Country:US
Practice Address - Phone:719-742-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility