Provider Demographics
NPI:1164646717
Name:THE MYRON STRATTON HOME
Entity Type:Organization
Organization Name:THE MYRON STRATTON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-579-0930
Mailing Address - Street 1:555 GOLD PASS HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3894
Mailing Address - Country:US
Mailing Address - Phone:719-579-0930
Mailing Address - Fax:719-579-0447
Practice Address - Street 1:555 GOLD PASS HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3894
Practice Address - Country:US
Practice Address - Phone:719-579-0930
Practice Address - Fax:719-579-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL0968310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04181756Medicaid
CO76554252Medicaid