Organization
1111 BONFORTE OPCO, LLC
Active
Organization
1111 BONFORTE OPCO, LLC
Active
Other names
Villa Pueblo Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN KIKLIS (CFO)
(303) 952-9216
Entity
Organization
Contact information
Practice address
855 HUNTER DR, PUEBLO, CO 81001-1867
(719) 545-5911
(719) 253-3709
Mailing address
2668 NORTHPARK DR, SUITE 220, LAFAYETTE, CO 80026-3199
(303) 952-9216
(303) 675-5659
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
09/09/2013
Last updated
09/26/2013
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