Provider Demographics
NPI:1871269365
Name:MADISON SENIOR LIVING MANAGEMENT LLC
Entity Type:Organization
Organization Name:MADISON SENIOR LIVING MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENDOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-952-9216
Mailing Address - Street 1:2668 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 5TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1932
Practice Address - Country:US
Practice Address - Phone:719-346-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON SENIOR LIVING MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95534741Medicaid