Provider Demographics
NPI:1376608505
Name:CARMEL COMMUNITY LIVING CORPORATION
Entity Type:Organization
Organization Name:CARMEL COMMUNITY LIVING CORPORATION
Other - Org Name:OVERTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:720-660-1844
Mailing Address - Street 1:451 21ST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1483
Mailing Address - Country:US
Mailing Address - Phone:303-444-0573
Mailing Address - Fax:720-600-5176
Practice Address - Street 1:425 S BOWEN ST STE 6
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6140
Practice Address - Country:US
Practice Address - Phone:720-660-1844
Practice Address - Fax:720-458-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
CO04B477251E00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05374367Medicaid