Healthcare Provider Details

I. General information

NPI: 1770306870
Provider Name (Legal Business Name): WHEATRIDGE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FENTON ST
WHEAT RIDGE CO
80214-8116
US

IV. Provider business mailing address

720 S COLORADO BLVD STE 211
GLENDALE CO
80246-1904
US

V. Phone/Fax

Practice location:
  • Phone: 303-238-0481
  • Fax: 303-233-3775
Mailing address:
  • Phone: 720-974-6278
  • Fax: 303-987-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARY KORETKE
Title or Position: DIRECTOR COST REPORTING
Credential:
Phone: 720-974-6278