Provider Demographics
NPI:1659732055
Name:COLORADO ASSISTED LIVING HOMES PANAMA
Entity Type:Organization
Organization Name:COLORADO ASSISTED LIVING HOMES PANAMA
Other - Org Name:COLORADO ASSISTED LIVING HOMES MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-549-1615
Mailing Address - Street 1:6638 W OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4562
Mailing Address - Country:US
Mailing Address - Phone:303-948-0555
Mailing Address - Fax:720-981-0233
Practice Address - Street 1:1051 E PANAMA DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2506
Practice Address - Country:US
Practice Address - Phone:303-798-0746
Practice Address - Fax:720-981-0233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO ASSISTED LIVING HOMES MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23M600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68023898Medicaid