Provider Demographics
NPI:1942453410
Name:MAKARIOS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:MAKARIOS ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUYATNO
Authorized Official - Middle Name:
Authorized Official - Last Name:FNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-404-1445
Mailing Address - Street 1:19148 E LASALLE PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6454
Mailing Address - Country:US
Mailing Address - Phone:720-404-1445
Mailing Address - Fax:303-933-2011
Practice Address - Street 1:7488 S KIT CARSON ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1495
Practice Address - Country:US
Practice Address - Phone:720-404-1445
Practice Address - Fax:303-933-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R160310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility