Provider Demographics
NPI:1881806362
Name:APPLELEAF ASSISTED LIVING INC..
Entity type:Organization
Organization Name:APPLELEAF ASSISTED LIVING INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-532-2600
Mailing Address - Street 1:1328 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-2803
Mailing Address - Country:US
Mailing Address - Phone:970-532-2600
Mailing Address - Fax:970-532-2600
Practice Address - Street 1:1328 1ST ST
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-2803
Practice Address - Country:US
Practice Address - Phone:970-532-2600
Practice Address - Fax:970-532-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0175310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47482567Medicaid