Provider Demographics
NPI:1174063713
Name:A WILDFLOWER ASSISTED LIVING AND CARE HOME INC
Entity type:Organization
Organization Name:A WILDFLOWER ASSISTED LIVING AND CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIAVONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-628-9092
Mailing Address - Street 1:1140 US HIGHWAY 287
Mailing Address - Street 2:400-298
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7080
Mailing Address - Country:US
Mailing Address - Phone:720-628-9092
Mailing Address - Fax:
Practice Address - Street 1:9423 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5237
Practice Address - Country:US
Practice Address - Phone:720-628-9092
Practice Address - Fax:866-941-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23H526310400000X
CO23A411310400000X
CO23O410310400000X
CO23X367310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000138301Medicaid
CO04405374Medicaid
CO9000133109Medicaid
CO9000143196Medicaid
CO9000133104Medicaid