Provider Demographics
NPI:1124325014
Name:CAMPBELL-MULJANAH ENTERPRISES
Entity type:Organization
Organization Name:CAMPBELL-MULJANAH ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-941-9460
Mailing Address - Street 1:4953 S FIELD CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1919
Mailing Address - Country:US
Mailing Address - Phone:303-941-9460
Mailing Address - Fax:303-694-5743
Practice Address - Street 1:4468 E LAKE CIR S
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-3314
Practice Address - Country:US
Practice Address - Phone:303-694-5743
Practice Address - Fax:303-694-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23Q703310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOTP139457AMedicaid