Organization Active NPI

Assisted Living at Greeley, LLC

  • Assisted Living Facility (Mental Illness)
  • Greeley, CO
National Provider Identifier
1023933967
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
ASSISTED LIVING AT GREELEY, LLC
Practice address
218 1/2 10TH Street
Greeley, CO 80631-4233
Phone
(970) 515-6952
Fax
(970) 515-6875
NPI assigned
Aug 11, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melany Sufianti Wong
Title
Administrator
Phone
(720) 635-4734

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X Primary
Assisted Living Facility (Behavioral Disturbances) 3104A0630X

Addresses

Primary practice location

218 1/2 10TH Street
Greeley, CO 80631-4233

Mailing address

P.O. Box 274
Parker, CO 80134-8998
Phone (720) 635-4734

Other identifiers 1

IdentifierTypeStateIssuer
9000131340MedicaidCO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2232606Assisted Living at Greeley218 1/2 10TH Street, Greeley, CO 80631Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory

Locations

218 10th St
Greeley, CO 80631

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1786406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786406400000",
    "number": "1023933967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 274",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801348998",
            "telephone_number": "720-635-4734",
            "fax_number": "720-420-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 1/2 10TH STREET",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314233",
            "telephone_number": "970-515-6952",
            "fax_number": "970-515-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSISTED LIVING AT GREELEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-11",
        "last_updated": "2026-08-11",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "MELANY",
        "authorized_official_middle_name": "SUFIANTI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "720-635-4734"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000131340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.