Provider Demographics
NPI:1437273927
Name:PAONIA INVESTMENTS AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:PAONIA INVESTMENTS AND ASSOCIATES LLC
Other - Org Name:PAONIA CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-308-1866
Mailing Address - Street 1:1625 MEADOWBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-9325
Mailing Address - Country:US
Mailing Address - Phone:970-527-4837
Mailing Address - Fax:970-527-5352
Practice Address - Street 1:1625 MEADOWBROOK BLVD
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428-9325
Practice Address - Country:US
Practice Address - Phone:970-527-4837
Practice Address - Fax:970-527-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO643314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16433548Medicaid
CO06-5251Medicare Oscar/Certification