Provider Demographics
NPI:1679509921
Name:ALADDIN ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:ALADDIN ASSISTED LIVING, LLC
Other - Org Name:ALADDIN AT BRUSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-2063
Mailing Address - Street 1:428 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-1726
Mailing Address - Country:US
Mailing Address - Phone:970-842-5463
Mailing Address - Fax:970-842-5463
Practice Address - Street 1:2415 MULLINS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-4274
Practice Address - Country:US
Practice Address - Phone:719-589-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0520310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60729236Medicaid