Provider Demographics
NPI:1205191129
Name:WINSLOW COURT COCSWC, LLC
Entity Type:Organization
Organization Name:WINSLOW COURT COCSWC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EVRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-859-5126
Mailing Address - Street 1:3920 E SAN MIGUEL ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3427
Mailing Address - Country:US
Mailing Address - Phone:719-597-1700
Mailing Address - Fax:719-574-6074
Practice Address - Street 1:3920 E SAN MIGUEL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3427
Practice Address - Country:US
Practice Address - Phone:719-597-1700
Practice Address - Fax:719-574-6074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STELLAR SENIOR LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230512310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO230512OtherPROVIDER LICENSE NUMBER