Provider Demographics
NPI:1609073774
Name:DOROTHY'S INC.
Entity Type:Organization
Organization Name:DOROTHY'S INC.
Other - Org Name:WIGGINS ASSISTED LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-483-7208
Mailing Address - Street 1:302 SALLY ST
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:CO
Mailing Address - Zip Code:80654-1404
Mailing Address - Country:US
Mailing Address - Phone:970-483-7208
Mailing Address - Fax:
Practice Address - Street 1:302 SALLY ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:CO
Practice Address - Zip Code:80654-1404
Practice Address - Country:US
Practice Address - Phone:970-482-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77472080Medicaid