Provider Demographics
NPI:1831562131
Name:ETERNAL LIFE CARE CENTERS, LLC
Entity type:Organization
Organization Name:ETERNAL LIFE CARE CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-423-7037
Mailing Address - Street 1:6196 W 75TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2806
Mailing Address - Country:US
Mailing Address - Phone:303-423-7037
Mailing Address - Fax:888-714-3305
Practice Address - Street 1:4370 INGALLS STREET
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-975-6723
Practice Address - Fax:888-714-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23M130310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25038761Medicaid