Provider Demographics
NPI:1972058790
Name:VANDY'S SUPPORTED LIVING SERVICES LLC
Entity Type:Organization
Organization Name:VANDY'S SUPPORTED LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUEANN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZIESK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-323-5553
Mailing Address - Street 1:303 E KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3719
Mailing Address - Country:US
Mailing Address - Phone:720-323-5553
Mailing Address - Fax:
Practice Address - Street 1:303 E KENYON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3719
Practice Address - Country:US
Practice Address - Phone:720-323-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care