Provider Demographics
NPI:1659790202
Name:CENTER AT CENTENNIAL, LLC
Entity Type:Organization
Organization Name:CENTER AT CENTENNIAL, LLC
Other - Org Name:CENTER AT CORDERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SENKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, NHA
Authorized Official - Phone:719-685-8888
Mailing Address - Street 1:9208 GRAND CORDERA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-522-2000
Mailing Address - Fax:719-522-2050
Practice Address - Street 1:9208 GRAND CORDERA PARKWAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-522-2000
Practice Address - Fax:719-522-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility