Provider Demographics
NPI:1902490097
Name:PADAKEN, CHERYLANN HAUNANI
Entity Type:Individual
Prefix:
First Name:CHERYLANN
Middle Name:HAUNANI
Last Name:PADAKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-1963
Mailing Address - Country:US
Mailing Address - Phone:720-369-4335
Mailing Address - Fax:
Practice Address - Street 1:1594 WALNUT DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1963
Practice Address - Country:US
Practice Address - Phone:720-369-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230357310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility