Provider Demographics
NPI:1770291650
Name:COLORADO RESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:COLORADO RESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARETIES
Authorized Official - Middle Name:MUIT
Authorized Official - Last Name:PONTOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-713-3535
Mailing Address - Street 1:436 N COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4839
Mailing Address - Country:US
Mailing Address - Phone:714-713-3535
Mailing Address - Fax:
Practice Address - Street 1:436 N COLORADO ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4839
Practice Address - Country:US
Practice Address - Phone:714-713-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility