Pueblo West Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL-0546 Issued in CO

Legal business name

PUEBLO WEST ASSISTED LIVING, LLC

Doing business as

Legacy Commons at Pueblo West

Practice address

170 S Dacona Dr
Pueblo West, CO 81007-5403

Phone

(719) 547-2538

Fax

(719) 547-8294

NPI assigned

Mar 29, 2006

Organization subpart

No

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

Authorized official

Name

Donald Kanen

Title

Cfo

Phone

(719) 589-2063

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Legacy Commons at Pueblo West Doing business as

Locations

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649231648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 MULLINS AVE",
            "address_2": "SUITE 4",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811014274",
            "telephone_number": "719-589-2063",
            "fax_number": "719-589-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 S DACONA DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075403",
            "telephone_number": "719-547-2538",
            "fax_number": "719-547-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO WEST ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KANEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "719-589-2063"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "AL-0546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04183257",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Commons at Pueblo West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Pueblo West, CO
• Providers in Pueblo West, CO by specialty
• Assisted Living Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.