Healthcare Provider Details

I. General information

NPI: 1922738632
Provider Name (Legal Business Name): BUCKEYE C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E BRIDGE ST
BRIGHTON CO
80601-2547
US

IV. Provider business mailing address

12136 W BAYAUD AVE STE 200
LAKEWOOD CO
80228-2115
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-2253
  • Fax: 303-659-6334
Mailing address:
  • Phone: 720-974-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY KORETKE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 720-974-6278