Provider Demographics
NPI:1225417512
Name:ALPINE ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:ALPINE ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALIK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-601-3538
Mailing Address - Street 1:1985 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1011
Mailing Address - Country:US
Mailing Address - Phone:303-755-8002
Mailing Address - Fax:303-755-8003
Practice Address - Street 1:1985 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1011
Practice Address - Country:US
Practice Address - Phone:303-755-8002
Practice Address - Fax:303-755-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO169342261QA0600X
COB-09977343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26837871Medicaid