Provider Demographics
NPI:1336749373
Name:TCAL2
Entity Type:Organization
Organization Name:TCAL2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-667-6890
Mailing Address - Street 1:3408 S PATTON WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2426
Mailing Address - Country:US
Mailing Address - Phone:303-667-6890
Mailing Address - Fax:303-975-2472
Practice Address - Street 1:6419 W MEXICO AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7055
Practice Address - Country:US
Practice Address - Phone:303-667-6890
Practice Address - Fax:303-975-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility