Healthcare Provider Details

I. General information

NPI: 1104813484
Provider Name (Legal Business Name): NORTHERN COLORADO REHABILITATION HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 UNION STREET
JOHNSTOWN CO
80534-2800
US

IV. Provider business mailing address

1024 N GALLOWAY AVE STE 102
MESQUITE TX
75149-2434
US

V. Phone/Fax

Practice location:
  • Phone: 970-619-3400
  • Fax: 970-278-9343
Mailing address:
  • Phone: 972-216-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number0591
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: DENISE KANN
Title or Position: VICE PRESIDENT AND SECRETARY
Credential:
Phone: 972-216-2299