Provider Demographics
NPI:1386019677
Name:TY'S HOUSE
Entity Type:Organization
Organization Name:TY'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-307-8332
Mailing Address - Street 1:PO BOX 390651
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-1651
Mailing Address - Country:US
Mailing Address - Phone:303-307-8332
Mailing Address - Fax:303-261-1112
Practice Address - Street 1:5050 TROY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-4338
Practice Address - Country:US
Practice Address - Phone:303-307-8332
Practice Address - Fax:303-261-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R990310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15655351Medicaid