Organization
GOSHEN ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARIJANTO SUGIARSO (PRESIDENT)
(303) 353-9041
Entity
Organization
Contact information
Practice address
12099 E LOUISIANA AVE, AURORA, CO 80012-4255
(303) 353-9041
(303) 353-2334
Mailing address
12099 E LOUISIANA AVE, AURORA, CO 80012-4255
(303) 353-9041
(303) 353-2334
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
23H948
CO
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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