ROBERT RUSSELL EASTERN STAR MASONIC CENTER NPI 1063887990

NPI Information

ROBERT RUSSELL EASTERN STAR MASONIC CENTER is an assisted living facility in Denver, CO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. ROBERT RUSSELL EASTERN STAR MASONIC CENTER NPI is 1063887990. The provider is registered as an organization entity type.

The provider's business location address is:

2445 S QUEBEC ST
DENVER, CO
ZIP 80231-030
Phone: (303) 756-9489

The provider's authorized official is Larry Lillo .
The authorized official title is Executive Director and has the following contact phone number (303) 756-9489.

The CLIA number assigned to this NPI record is 06D2231220 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/3/2015 and was last updated on 12/3/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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