Organization
YOUR SECOND HOME LLC
Active
Other names
Front Range Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
EARL VANZE CO (MANAGER)
(518) 882-8383
Entity
Organization
Contact information
Practice address
3880 DOVER ST, WHEAT RIDGE, CO 80033-4317
(303) 424-1266
Mailing address
3880 DOVER ST, WHEAT RIDGE, CO 80033-4317
(303) 424-1266
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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