Healthcare Provider Details

I. General information

NPI: 1821664343
Provider Name (Legal Business Name): COORDINATED HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 E YALE AVE
DENVER CO
80222-6902
US

IV. Provider business mailing address

1835A S CENTRE CITY PKWY # 513
ESCONDIDO CA
92025-6525
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-1209
  • Fax:
Mailing address:
  • Phone: 619-948-6611
  • Fax: 951-654-9307

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: MRS. TANYA CASSIE PONTECORVO
Title or Position: DIRECTOR OF OPERATIONS
Credential: NHA
Phone: 619-948-6611