Provider Demographics
NPI:1194196055
Name:XANADU ASSISTED HOME CARE
Entity Type:Organization
Organization Name:XANADU ASSISTED HOME CARE
Other - Org Name:XANADU ASSISTED LIVING RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:RAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-425-7285
Mailing Address - Street 1:1391 XANADU ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6532
Mailing Address - Country:US
Mailing Address - Phone:303-364-9630
Mailing Address - Fax:
Practice Address - Street 1:1391 XANADU ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6532
Practice Address - Country:US
Practice Address - Phone:303-364-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23K605310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility