Provider Demographics
NPI:1518544592
Name:CENTREPOINT SUPPORT LIVING, LLC
Entity Type:Organization
Organization Name:CENTREPOINT SUPPORT LIVING, LLC
Other - Org Name:CENTREPOINTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-591-2185
Mailing Address - Street 1:6892 S YOSEMITE CT # 1-101A
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1464
Mailing Address - Country:US
Mailing Address - Phone:303-591-2185
Mailing Address - Fax:
Practice Address - Street 1:6892 S YOSEMITE CT # 1-101A
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1464
Practice Address - Country:US
Practice Address - Phone:303-591-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141253Medicaid