Provider Demographics
NPI:1619383296
Name:MAKARIOS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MAKARIOS ASSISTED LIVING LLC
Other - Org Name:YAMPA MAKARIOS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUYATNO
Authorized Official - Middle Name:
Authorized Official - Last Name:FNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-404-1445
Mailing Address - Street 1:2936 S YAMPA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6162
Mailing Address - Country:US
Mailing Address - Phone:720-404-1445
Mailing Address - Fax:303-993-7505
Practice Address - Street 1:19148 E LASALLE PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6454
Practice Address - Country:US
Practice Address - Phone:720-404-1445
Practice Address - Fax:303-993-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23M211310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility