Provider Demographics
NPI:1538322706
Name:LITTLE SISTERS OF THE POOR MULLEN HOME
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR MULLEN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-433-7221
Mailing Address - Street 1:3629 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3601
Mailing Address - Country:US
Mailing Address - Phone:303-433-7221
Mailing Address - Fax:303-477-0519
Practice Address - Street 1:3629 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3601
Practice Address - Country:US
Practice Address - Phone:303-433-7221
Practice Address - Fax:303-477-0519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE SISTERS OF THE POOR MULLEN HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304J5310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140349Medicaid