Provider Demographics
NPI:1134755796
Name:329 EXEMPLA CIRCLE OPERATIONS LLC
Entity type:Organization
Organization Name:329 EXEMPLA CIRCLE OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ASST SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:329 EXEMPLA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3482
Mailing Address - Country:US
Mailing Address - Phone:720-639-2200
Mailing Address - Fax:
Practice Address - Street 1:329 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3482
Practice Address - Country:US
Practice Address - Phone:720-639-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO126583224OtherSNF NPI
CO065414OtherMEDICARE