Provider Demographics
NPI:1730783861
Name:COLORADO SENIOR CARE
Entity type:Organization
Organization Name:COLORADO SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VANBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-666-5116
Mailing Address - Street 1:1427 S FEDERAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219
Mailing Address - Country:US
Mailing Address - Phone:720-305-2864
Mailing Address - Fax:303-954-9531
Practice Address - Street 1:1427 S FEDERAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219
Practice Address - Country:US
Practice Address - Phone:720-305-2864
Practice Address - Fax:303-954-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care