Provider Demographics
NPI:1144855594
Name:JERUSALEM ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:JERUSALEM ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EYERUSALEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-632-8383
Mailing Address - Street 1:4783 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4933
Mailing Address - Country:US
Mailing Address - Phone:303-632-8383
Mailing Address - Fax:
Practice Address - Street 1:4783 CHANDLER CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-4933
Practice Address - Country:US
Practice Address - Phone:303-632-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERUSALEM ASSISTED LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-05
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251B00000XAgenciesCase Management