NPIMap

Organization Active NPI

1111 Bonforte Opco, LLC

Doing business as Villa Pueblo Assisted Living

  • Assisted Living Facility
  • Pueblo, CO
National Provider Identifier
1669807731
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
1111 BONFORTE OPCO, LLC
Doing business as
Villa Pueblo Assisted Living
Practice address
855 Hunter Dr
Pueblo, CO 81001-1867
Phone
(719) 545-5911
Fax
(719) 253-3709
NPI assigned
Sep 9, 2013
Last updated
Sep 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Authorized official

Name
Dean Kiklis
Title
Cfo
Phone
(303) 952-9216

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

855 Hunter Dr
Pueblo, CO 81001-1867

Mailing address

2668 Northpark Dr
Suite 220
Lafayette, CO 80026-3199
Phone (303) 952-9216

Other names 1

  • Villa Pueblo Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
1111 Bonforte Opco LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1669807731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2668 NORTHPARK DR",
            "address_2": "SUITE 220",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800263199",
            "telephone_number": "303-952-9216",
            "fax_number": "303-675-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 HUNTER DR",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011867",
            "telephone_number": "719-545-5911",
            "fax_number": "719-253-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1111 BONFORTE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-26",
        "status": "A",
        "authorized_official_last_name": "KIKLIS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-952-9216"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villa Pueblo Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; 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.