Healthcare Provider Details

I. General information

NPI: 1295179604
Provider Name (Legal Business Name): COLUMBINE COMMONS HEALTH & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 01/28/2022
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 MAIN ST
WINDSOR CO
80550-6029
US

IV. Provider business mailing address

1475 MAIN STREET
WINDSOR CO
80550-5990
US

V. Phone/Fax

Practice location:
  • Phone: 970-449-5540
  • Fax:
Mailing address:
  • Phone: 970-449-5540
  • Fax: 970-482-9148

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: MR. BARRY K FANCHER
Title or Position: CCO/CFO
Credential:
Phone: 970-482-0198