Provider Demographics
NPI:1477518470
Name:GOLDEN WEST COMMUNITIES, INC.
Entity Type:Organization
Organization Name:GOLDEN WEST COMMUNITIES, INC.
Other - Org Name:FIRST CHRISTIAN MANOR, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-444-3967
Mailing Address - Street 1:1055 ADAMS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:303-444-3967
Mailing Address - Fax:303-939-0808
Practice Address - Street 1:1055 ADAMS CIRCLE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-444-3967
Practice Address - Fax:303-939-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0555310400000X
CO230379310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04141453Medicaid