Provider Demographics
NPI:1194362012
Name:ASPEN LEAF ASSISTED LIVING RESIDENCE INC
Entity Type:Organization
Organization Name:ASPEN LEAF ASSISTED LIVING RESIDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-906-1643
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815-0426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 PAWNEE AVENUE
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815
Practice Address - Country:US
Practice Address - Phone:303-906-1643
Practice Address - Fax:888-898-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility