Ioof Grand Lodge Of Colorado
Assisted Living Facility in Canon City, CO. Organization (NPI-2).
NPI number1073754693
StatusActive
Last updated in NPPESMar 11, 2009
Details
- NPI
- 1073754693
- Entity type
- Organization (NPI-2)
- Legal business name
- Ioof Grand Lodge Of Colorado
- Organization subpart
- No
- Enumeration date
- Mar 11, 2009
- Last updated
- Mar 11, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | 23C967 | CO | Yes |
Other names
- Friendship House At The Home (Doing Business As)
Practice location
1020 N 15th StCanon City, CO 81212-2344
Phone 719-275-7451
Mailing address
1545 Phelps AveCanon City, CO 81212-4650
Phone 719-275-7451
Authorized official
Dennis G Prather
Executive Director
7192757451
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