Organization
ROBERT RUSSELL EASTERN STAR MASONIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW WISTREICH (EXECUTIVE DIRECTOR)
(303) 753-2174
Entity
Organization
Contact information
Practice address
2445 S QUEBEC ST, DENVER, CO 80231-6030
(303) 753-2172
Mailing address
2445 S QUEBEC ST, DENVER, CO 80231-6030
(303) 753-2172
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
2304HP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04183240
—
CO
Enumeration date
03/31/2008
Last updated
03/31/2008
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