Ioof Grand Lodge of Colorado
NPI #1073754693 in Canon City, Colorado
Provider Information
- NPI Number
- 1073754693
- Entity Type
- Organization
- Organization Name
- Ioof Grand Lodge of Colorado
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Mar 11, 2009
- Last Updated
- Mar 11, 2009
Practice Location
- Address
- 1020 N 15TH ST
- City
- Canon City
- State
- Colorado
- ZIP Code
- 81212-2344
- Phone
- (719) 275-7451
Authorized Official
- Name
- MR. DENNIS G PRATHER
- Title
- EXECUTIVE DIRECTOR
- Phone
- (719) 275-7451
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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