Provider Demographics
NPI:1265843676
Name:ACTIVE HEARTS ADULT DAY PROGRAM, LLC
Entity Type:Organization
Organization Name:ACTIVE HEARTS ADULT DAY PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPOVALOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-477-1717
Mailing Address - Street 1:3000 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3414
Practice Address - Country:US
Practice Address - Phone:720-477-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care