Provider Demographics
NPI:1467516740
Name:MANORCARE HEALTH SERVICES BOULDER
Entity Type:Organization
Organization Name:MANORCARE HEALTH SERVICES BOULDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-440-9100
Mailing Address - Street 1:2800 PALO PKWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1540
Mailing Address - Country:US
Mailing Address - Phone:303-440-9100
Mailing Address - Fax:303-440-9251
Practice Address - Street 1:2800 PALO PKWY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1540
Practice Address - Country:US
Practice Address - Phone:303-440-9100
Practice Address - Fax:303-440-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1295314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1992742258OtherNPI
CO63936364Medicaid
CO63936364Medicaid