Provider Demographics
NPI:1407215429
Name:MAIRIK ADULT DAY CARE
Entity Type:Organization
Organization Name:MAIRIK ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ARTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEVOSYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-960-4732
Mailing Address - Street 1:7255 S HAVANA ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3887
Mailing Address - Country:US
Mailing Address - Phone:303-960-4732
Mailing Address - Fax:303-736-2195
Practice Address - Street 1:7255 S HAVANA ST STE 130
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3887
Practice Address - Country:US
Practice Address - Phone:303-960-4732
Practice Address - Fax:303-736-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60608587Medicaid