Organization
IOOF GRAND LODGE OF COLORADO
Active
Organization
IOOF GRAND LODGE OF COLORADO
Active
Other names
Friendship House At The Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS G PRATHER (EXECUTIVE DIRECTOR)
(719) 275-7451
Entity
Organization
Contact information
Practice address
1020 N 15TH ST, CANON CITY, CO 81212-2344
(719) 275-7451
Mailing address
1545 PHELPS AVE, CANON CITY, CO 81212-4650
(719) 275-7451
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
23C967
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23C967
—
CO
Enumeration date
03/11/2009
Last updated
03/11/2009
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