MEDICARE: POPLAR GROVE HEALTH & REHAB, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174595169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPLAR GROVE HEALTH & REHAB, INC

Provider Business Mailing Address
First Line	:	PO BOX 155635
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-0635
Country	:	US
Telephone Number	:	817-359-2000
Fax Number	:	817-359-2093

Provider Business Practice Location Address
First Line	:	7150 POPLAR ST
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-2147
Country	:	US
Telephone Number	:	303-289-7110
Fax Number	:	303-288-3517

Authorized Official
Title or Position	:	CEO
Name	:	GARY R TREBERT
Credential	:
Telephone Number	:	817-359-2000

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	08/22/2020

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