Provider Demographics
NPI:1821301938
Name:ASSISTED LIVING AT FLOYD, LLC
Entity Type:Organization
Organization Name:ASSISTED LIVING AT FLOYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIKTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLYACHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-480-1326
Mailing Address - Street 1:4076 S CARSON WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-8101
Mailing Address - Country:US
Mailing Address - Phone:720-480-1326
Mailing Address - Fax:303-757-5145
Practice Address - Street 1:2330 E FLOYD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3124
Practice Address - Country:US
Practice Address - Phone:720-480-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23049N305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service