Provider Demographics
NPI:1881659332
Name:SENIOR LIVING OF LAKEWOOD, LLC
Entity Type:Organization
Organization Name:SENIOR LIVING OF LAKEWOOD, LLC
Other - Org Name:BRIGHTON GARDENS OF LAKEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-237-5700
Mailing Address - Street 1:7900 WESTPARK DR
Mailing Address - Street 2:T-900 ATTN: MEDICARE BILLING, M. GARCIA
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4242
Mailing Address - Country:US
Mailing Address - Phone:703-854-0823
Mailing Address - Fax:703-854-0164
Practice Address - Street 1:12791 W ALAMEDA PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2857
Practice Address - Country:US
Practice Address - Phone:303-237-5700
Practice Address - Fax:303-237-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0878314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065374Medicare ID - Type Unspecified