Provider Demographics
NPI:1306043260
Name:MANAGED CARE INC
Entity Type:Organization
Organization Name:MANAGED CARE INC
Other - Org Name:LIFETIME ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-444-4248
Mailing Address - Street 1:PO BOX 17938
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-0938
Mailing Address - Country:US
Mailing Address - Phone:303-444-4248
Mailing Address - Fax:303-431-5276
Practice Address - Street 1:9160 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3111
Practice Address - Country:US
Practice Address - Phone:303-444-4248
Practice Address - Fax:303-531-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0521310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04182028Medicaid