Provider Demographics
NPI:1629762000
Name:LAFAYETTE COMMUNITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LAFAYETTE COMMUNITY HEALTHCARE, LLC
Other - Org Name:COAL CREEK POST ACUTE & ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/ASST SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-988-3319
Mailing Address - Street 1:262 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2975
Mailing Address - Country:US
Mailing Address - Phone:801-447-9823
Mailing Address - Fax:
Practice Address - Street 1:329 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3482
Practice Address - Country:US
Practice Address - Phone:720-639-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility