Organization
PUEBLO WEST ASSISTED LIVING, LLC
Active
Other names
Legacy Commons at Pueblo West
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD KANEN (CFO)
(719) 589-2063
Entity
Organization
Contact information
Practice address
170 S DACONA DR, PUEBLO WEST, CO 81007-5403
(719) 547-2538
(719) 547-8294
Mailing address
2415 MULLINS AVE, SUITE 4, ALAMOSA, CO 81101-4274
(719) 589-2063
(719) 589-8891
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL-0546
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04183257
—
CO
Enumeration date
03/29/2006
Last updated
08/22/2020
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