Healthcare Provider Details

I. General information

NPI: 1962493809
Provider Name (Legal Business Name): BUCKEYE A, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/25/2016
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

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

V. Phone/Fax

Practice location:
  • Phone: 303-761-0260
  • Fax: 303-761-7088
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 Number0318
License Number StateCO

VIII. Authorized Official

Name: JAY MOSKOWITZ
Title or Position: PRESIDENT
Credential: CPA
Phone: 303-238-3838