Elderhaus Adult Day Program, Inc

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

ELDERHAUS ADULT DAY PROGRAM, INC

Practice address

6813 S College Ave
Fort Collins, CO 80525-4144

Phone

(970) 221-0406

NPI assigned

Jul 15, 2015

Organization subpart

No

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

Authorized official

Name

Joanne R Vande Walle

Title

Executive Director

Phone

(970) 221-0406

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485907200000",
    "number": "1073997417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6813 S COLLEGE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254144",
            "telephone_number": "970-221-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6813 S COLLEGE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254144",
            "telephone_number": "970-221-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERHAUS ADULT DAY PROGRAM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2017-02-01",
        "status": "A",
        "authorized_official_last_name": "VANDE WALLE",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-221-0406"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04000790",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61522562",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.