Organization
BSLC II
Active
Other names
Collinwood
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M WILSON (ACCOUNTING MANAGER)
(719) 481-0100
Entity
Organization
Contact information
Practice address
5055 S LEMAY AVE, FORT COLLINS, CO 80525-9401
(970) 530-0223
(970) 223-3360
Mailing address
15475 GLENEAGLE DR, COLORADO SPRINGS, CO 80921-2596
(719) 481-0100
(719) 488-6080
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53879562
—
CO
Enumeration date
04/29/2021
Last updated
04/29/2021
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