Healthcare Provider Details

I. General information

NPI: 1689111783
Provider Name (Legal Business Name): BUCKEYE A, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S FEDERAL BLVD
DENVER CO
80236-2713
US

IV. Provider business mailing address

3131 S FEDERAL BLVD
DENVER CO
80236-2713
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-0260
  • Fax: 303-796-7088
Mailing address:
  • Phone: 303-761-0260
  • Fax: 303-796-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020405
License Number StateCO

VIII. Authorized Official

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