Provider Demographics
NPI:1356324578
Name:LITTLE SISTERS OF THE POOR MULLEN HOME FOR THE AGED
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR MULLEN HOME FOR THE AGED
Other - Org Name:LITTLE SISTERS OF THE POOR
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENT ACCTS BOOK KEEPER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-433-7221
Mailing Address - Street 1:3629 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3601
Mailing Address - Country:US
Mailing Address - Phone:303-433-7221
Mailing Address - Fax:303-477-0519
Practice Address - Street 1:3629 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3601
Practice Address - Country:US
Practice Address - Phone:303-433-7221
Practice Address - Fax:303-477-0519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE SISTERS OF THE POOR MULLEN HOME FOR THE AGED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140349Medicaid
CO05653753Medicaid