Provider Demographics
NPI:1295395358
Name:CAPPELLA PUEBLO WEST LLC
Entity Type:Organization
Organization Name:CAPPELLA PUEBLO WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-974-3555
Mailing Address - Street 1:9570 S KINGSTON CT STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6004
Mailing Address - Country:US
Mailing Address - Phone:720-974-3555
Mailing Address - Fax:720-974-3561
Practice Address - Street 1:170 S DACONA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5403
Practice Address - Country:US
Practice Address - Phone:719-547-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility