Provider Demographics
NPI:1457991705
Name:SEB'S RECREATION CENTER
Entity Type:Organization
Organization Name:SEB'S RECREATION CENTER
Other - Org Name:SEB'S RECREATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-353-9822
Mailing Address - Street 1:1710 S BUCKLEY RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5639
Mailing Address - Country:US
Mailing Address - Phone:303-353-9822
Mailing Address - Fax:
Practice Address - Street 1:1710 S BUCKLEY RD UNIT 9
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5639
Practice Address - Country:US
Practice Address - Phone:303-353-9822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80017Medicaid
CO80017OtherRECREATION