Provider Demographics
NPI:1669158259
Name:HEATHER GROVE ASSISTED LIVING, INC
Entity type:Organization
Organization Name:HEATHER GROVE ASSISTED LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUPIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-993-6265
Mailing Address - Street 1:3289 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3286
Mailing Address - Country:US
Mailing Address - Phone:303-477-4262
Mailing Address - Fax:303-477-0720
Practice Address - Street 1:3289 GROVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3286
Practice Address - Country:US
Practice Address - Phone:303-477-4262
Practice Address - Fax:303-477-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility