Provider Demographics
NPI:1255078838
Name:DESHANO CARE CENTERS LLC
Entity type:Organization
Organization Name:DESHANO CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUKONTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-601-1404
Mailing Address - Street 1:2150 W 29TH AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3869
Mailing Address - Country:US
Mailing Address - Phone:720-601-1404
Mailing Address - Fax:
Practice Address - Street 1:8010 W 63RD AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3412
Practice Address - Country:US
Practice Address - Phone:303-803-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESHANO CARE CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility