Provider Demographics
NPI:1356876700
Name:OUR FAMILY CARE HOME ASSISTED LIVING LLC
Entity type:Organization
Organization Name:OUR FAMILY CARE HOME ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-960-8300
Mailing Address - Street 1:1169 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:541-598-5336
Mailing Address - Fax:303-237-1690
Practice Address - Street 1:1169 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:541-598-5336
Practice Address - Fax:303-237-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities