Provider Demographics
NPI:1760207047
Name:ICARE ASSISTED LIVING FACILITY LLC
Entity type:Organization
Organization Name:ICARE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAHRREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLASTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-313-6385
Mailing Address - Street 1:7820 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3183
Mailing Address - Country:US
Mailing Address - Phone:720-313-6385
Mailing Address - Fax:
Practice Address - Street 1:7820 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3183
Practice Address - Country:US
Practice Address - Phone:720-313-6385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility