Provider Demographics
NPI:1295217511
Name:DESHANO CARE CENTERS LLC
Entity Type:Organization
Organization Name:DESHANO CARE CENTERS LLC
Other - Org Name:FLOURISH SUPPORTIVE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUKONTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-803-6977
Mailing Address - Street 1:2150 W 29TH AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3844
Mailing Address - Country:US
Mailing Address - Phone:303-803-6977
Mailing Address - Fax:
Practice Address - Street 1:8217 W PEAKVIEW DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3577
Practice Address - Country:US
Practice Address - Phone:303-803-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23A928310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility