Provider Demographics
NPI:1275855058
Name:AZURA OF LAKEWOOD, LLC
Entity Type:Organization
Organization Name:AZURA OF LAKEWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERONIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-938-8000
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-0894
Mailing Address - Country:US
Mailing Address - Phone:303-938-8000
Mailing Address - Fax:877-678-0642
Practice Address - Street 1:7395 WEST EASTMAN PLACE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5039
Practice Address - Country:US
Practice Address - Phone:303-730-8000
Practice Address - Fax:303-730-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility