Provider Demographics
NPI:1275518383
Name:EXEMPLA INC.
Entity Type:Organization
Organization Name:EXEMPLA INC.
Other - Org Name:EXEMPLA LUTHERAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP- CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-467-4430
Mailing Address - Street 1:8300 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6005
Mailing Address - Country:US
Mailing Address - Phone:303-813-5300
Mailing Address - Fax:
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-813-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXEMPLA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-12
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0083314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065326Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER