Provider Demographics
NPI:1003865635
Name:BLC - VILLAGE AT SKYLINE, LLC
Entity type:Organization
Organization Name:BLC - VILLAGE AT SKYLINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:FC
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5443
Mailing Address - Street 1:2365 PATRIOT HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-5122
Mailing Address - Country:US
Mailing Address - Phone:719-667-5360
Mailing Address - Fax:
Practice Address - Street 1:2365 PATRIOT HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-5122
Practice Address - Country:US
Practice Address - Phone:719-667-5360
Practice Address - Fax:719-473-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065382Medicare Oscar/Certification