Healthcare Provider Details

I. General information

NPI: 1992796874
Provider Name (Legal Business Name): BUCKEYE C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E BRIDGE STREET
BRIGHTON CO
80601-2547
US

IV. Provider business mailing address

12136 W. BAYAUD AVENUE SUITE 200
LAKEWOOD CO
80228-2115
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-2253
  • Fax: 303-659-6334
Mailing address:
  • Phone: 303-238-3838
  • Fax: 303-987-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020312
License Number StateCO

VIII. Authorized Official

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