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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