Provider Demographics
NPI:1700981644
Name:COVENANT LIVING OF COLORADO
Entity Type:Organization
Organization Name:COVENANT LIVING OF COLORADO
Other - Org Name:THE VILLAGE CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-4430
Mailing Address - Street 1:9153 YARROW ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4561
Mailing Address - Country:US
Mailing Address - Phone:303-424-4828
Mailing Address - Fax:303-424-0320
Practice Address - Street 1:9221 WADSWORTH PKWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4598
Practice Address - Country:US
Practice Address - Phone:303-424-4828
Practice Address - Fax:303-424-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000314000000X
CO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29538572Medicaid
CO29538572Medicaid