Provider Demographics
NPI:1053783159
Name:SILL HOMES
Entity type:Organization
Organization Name:SILL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-579-4317
Mailing Address - Street 1:2005 TABLE MESA DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5635
Mailing Address - Country:US
Mailing Address - Phone:720-579-4317
Mailing Address - Fax:
Practice Address - Street 1:2005 TABLE MESA DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5635
Practice Address - Country:US
Practice Address - Phone:720-579-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320900000X
CO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities