Healthcare Provider Details

I. General information

NPI: 1922907914
Provider Name (Legal Business Name): NORTHGLENN SC OPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 MALLEY DR
NORTHGLENN CO
80233-2024
US

IV. Provider business mailing address

451 MALLEY DR
NORTHGLENN CO
80233-2024
US

V. Phone/Fax

Practice location:
  • Phone: 303-378-8320
  • Fax:
Mailing address:
  • Phone: 303-378-8320
  • Fax:

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: MARY MARY KORETKE
Title or Position: DIRECTOR COST REPORTING
Credential: KORETKE
Phone: 303-378-8320