Organization
TOTAL LONGTERM CARE, INC
Active
Parent organization
TOTAL LONG TERM CARE
Other names
InnovAge Colorado PACE-Pueblo
Organization subpart
Yes
Provider details
NPI number
Legal business name
TOTAL LONG TERM CARE
Authorized official
MRS. GAYLE M WASHINGTON (CREDENTIALING COORDINATOR)
(303) 912-7193
Entity
Organization
Contact information
Practice address
401 W NORTHERN AVE, PUEBLO, CO 81004-3111
(719) 553-0400
Mailing address
8950 E LOWRY BLVD, DENVER, CO 80230-7030
(303) 912-7193
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O1336363
—
CO
Enumeration date
12/30/2020
Last updated
12/30/2020
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