Provider Demographics
NPI:1568165926
Name:CENTENNIALSD, INC.
Entity Type:Organization
Organization Name:CENTENNIALSD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL GROWTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-543-2170
Mailing Address - Street 1:10328 HUNTERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8801
Mailing Address - Country:US
Mailing Address - Phone:720-543-2170
Mailing Address - Fax:
Practice Address - Street 1:10328 HUNTERWOOD WAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-8801
Practice Address - Country:US
Practice Address - Phone:720-543-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care