NPIMap

Organization Active NPI

Brea East Mesa, LLC

Doing business as Brookdale Palmer Park

  • Assisted Living Facility
  • Colorado Springs, CO
National Provider Identifier
1821276510
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
68533250 Issued in CO
Legal business name
BREA EAST MESA, LLC
Doing business as
Brookdale Palmer Park
Practice address
2850 N Academy Blvd
Colorado Springs, CO 80917
Phone
(480) 832-1300
Fax
(480) 638-0841
NPI assigned
Feb 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Authorized official

Name
Bryan Richardson
Title
Evp, Chief Admin. Officer
Phone
(615) 564-8131

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 2305S9 CO
Assisted Living Facility 310400000X 68533250 CO Primary
Alzheimer Center (Dementia Center) 311500000X 2305S9 CO

Addresses

Primary practice location

2850 N Academy Blvd
Colorado Springs, CO 80917

Mailing address

6737 W Washington St Ste 2300
Milwaukee, WI 53214-5650
Phone (414) 918-5000

Other identifiers 3

IdentifierTypeStateIssuer
205629MedicaidCO
79559301MedicaidCO
00000OtherPRIVATE

Other names 1

  • Brookdale Palmer Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brea Charlotte LLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

2850 N Academy Blvd
Colorado Springs, CO 80917
Phone (480) 832-1300

NPI Registry JSON

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1821276510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST STE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145650",
            "telephone_number": "414-918-5000",
            "fax_number": "206-301-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 N ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "480-832-1300",
            "fax_number": "480-638-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREA EAST MESA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "EVP, CHIEF ADMIN. OFFICER",
        "authorized_official_telephone_number": "615-564-8131"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "2305S9",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "68533250",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "CO",
            "license": "2305S9",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205629",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79559301",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE",
            "identifier": "00000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Palmer Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.