Provider Demographics
NPI:1255882098
Name:CARLA'S CLUSTER CARE INC
Entity type:Organization
Organization Name:CARLA'S CLUSTER CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-775-9412
Mailing Address - Street 1:2050 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-2114
Mailing Address - Country:US
Mailing Address - Phone:719-775-9412
Mailing Address - Fax:
Practice Address - Street 1:1750 CIRCLE LANE
Practice Address - Street 2:
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828-2114
Practice Address - Country:US
Practice Address - Phone:719-775-9031
Practice Address - Fax:719-775-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23L627310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23L627Medicaid