Organization
ROBERT RUSSELL EASTERN STAR MASONIC CENTER
Active
Organization
ROBERT RUSSELL EASTERN STAR MASONIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY LILLO (EXECUTIVE DIRECTOR)
(303) 756-9489
Entity
Organization
Contact information
Practice address
2445 S QUEBEC ST, DENVER, CO 80231-6030
(303) 756-9489
Mailing address
2445 S QUEBEC ST, DENVER, CO 80231-6030
(303) 756-9489
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
12/03/2015
Last updated
12/03/2015
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