Provider Demographics
NPI:1346244969
Name:WIDE HORIZON, INC.
Entity Type:Organization
Organization Name:WIDE HORIZON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BOETTIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-424-4445
Mailing Address - Street 1:8900 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4204
Mailing Address - Country:US
Mailing Address - Phone:303-424-4445
Mailing Address - Fax:303-422-6373
Practice Address - Street 1:8900 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4204
Practice Address - Country:US
Practice Address - Phone:303-424-4445
Practice Address - Fax:303-422-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0107282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO061991Medicare ID - Type UnspecifiedLONG TERM CARE FACILITY