Provider Demographics
NPI:1578929428
Name:PRIMA ADULT DAY CARE
Entity Type:Organization
Organization Name:PRIMA ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVOSELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-524-9206
Mailing Address - Street 1:6630 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3004
Mailing Address - Country:US
Mailing Address - Phone:720-524-9206
Mailing Address - Fax:
Practice Address - Street 1:6630 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3004
Practice Address - Country:US
Practice Address - Phone:720-524-9206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79155075Medicaid