Healthcare Provider Details

I. General information

NPI: 1790782639
Provider Name (Legal Business Name): NORTH SHORE MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 29TH ST
LOVELAND CO
80538-2561
US

IV. Provider business mailing address

1365 W 29TH ST
LOVELAND CO
80538-2561
US

V. Phone/Fax

Practice location:
  • Phone: 970-677-6111
  • Fax: 970-667-2460
Mailing address:
  • Phone: 970-677-6111
  • Fax: 970-667-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0214
License Number StateCO

VIII. Authorized Official

Name: MRS. DEB PRENTISS
Title or Position: A/R MANAGER
Credential:
Phone: 970-482-0198