Provider Demographics
NPI:1356084727
Name:CITADEL ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:CITADEL ASSISTED LIVING LLC
Other - Org Name:SOLANGE AT THE CITADEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-391-4444
Mailing Address - Street 1:1900 E PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5850
Mailing Address - Country:US
Mailing Address - Phone:719-391-4444
Mailing Address - Fax:
Practice Address - Street 1:431 QUINCY ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2027
Practice Address - Country:US
Practice Address - Phone:719-382-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility