Provider Demographics
NPI:1932793726
Name:TRIPLE RRR
Entity Type:Organization
Organization Name:TRIPLE RRR
Other - Org Name:EDDIE'S HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ROZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-301-1369
Mailing Address - Street 1:1724 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3333
Mailing Address - Country:US
Mailing Address - Phone:719-560-9415
Mailing Address - Fax:719-696-9103
Practice Address - Street 1:1724 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3333
Practice Address - Country:US
Practice Address - Phone:719-560-9415
Practice Address - Fax:719-696-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness