Provider Demographics
NPI:1629255351
Name:WILLCAT
Entity Type:Organization
Organization Name:WILLCAT
Other - Org Name:IVY COTTAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICER
Authorized Official - Phone:719-482-4731
Mailing Address - Street 1:2060 PIMA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1748
Mailing Address - Country:US
Mailing Address - Phone:719-596-0076
Mailing Address - Fax:719-380-0756
Practice Address - Street 1:2060 PIMA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1748
Practice Address - Country:US
Practice Address - Phone:719-596-0076
Practice Address - Fax:719-380-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18553575Medicaid