Provider Demographics
NPI:1366443350
Name:LARCHWOOD INNS INC
Entity Type:Organization
Organization Name:LARCHWOOD INNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:R,N, NHA
Authorized Official - Phone:970-245-0022
Mailing Address - Street 1:2845 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-5219
Mailing Address - Country:US
Mailing Address - Phone:970-245-0022
Mailing Address - Fax:970-245-0044
Practice Address - Street 1:2845 N 15TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-5219
Practice Address - Country:US
Practice Address - Phone:970-245-0022
Practice Address - Fax:970-245-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652334Medicaid
CO05652334Medicaid