Healthcare Provider Details

I. General information

NPI: 1417830357
Provider Name (Legal Business Name): CRESTMOOR CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 S MONACO PKWY
DENVER CO
80224-1501
US

IV. Provider business mailing address

895 S MONACO PKWY
DENVER CO
80224-1501
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-3110
  • Fax: 303-321-1581
Mailing address:
  • Phone: 303-321-3110
  • Fax: 303-321-1581

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, COST REPORTING
Credential:
Phone: 720-974-6278