Provider Demographics
NPI:1851735542
Name:COLORADO SENIOR RESIDENCES, INC
Entity Type:Organization
Organization Name:COLORADO SENIOR RESIDENCES, INC
Other - Org Name:CASEY'S POND SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLS
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:970-846-4326
Mailing Address - Street 1:2855 OWL HOOT TRL
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-9160
Mailing Address - Country:US
Mailing Address - Phone:970-879-8855
Mailing Address - Fax:
Practice Address - Street 1:2855 OWL HOOT TRL
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-9160
Practice Address - Country:US
Practice Address - Phone:970-879-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility