Provider Demographics
NPI:1417481144
Name:ANDIRA INC
Entity Type:Organization
Organization Name:ANDIRA INC
Other - Org Name:PINEYCREEK ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMITERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-520-3009
Mailing Address - Street 1:PO BOX 631053
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80163-1053
Mailing Address - Country:US
Mailing Address - Phone:303-797-9110
Mailing Address - Fax:720-204-2652
Practice Address - Street 1:6666 S PINEY CREEK CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1108
Practice Address - Country:US
Practice Address - Phone:303-797-9110
Practice Address - Fax:720-204-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23I538310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility