Healthcare Provider Details

I. General information

NPI: 1053310839
Provider Name (Legal Business Name): RENOTTA HEALTH CARE SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CANYON RIDGE DR
WRAY CO
80758-8947
US

IV. Provider business mailing address

PO BOX 100 360 CANYON RIDGE DR.
WRAY CO
80758-0100
US

V. Phone/Fax

Practice location:
  • Phone: 970-332-4856
  • Fax: 970-332-4882
Mailing address:
  • Phone: 970-332-4856
  • Fax: 970-332-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-842
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0668
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number94871868
License Number StateCO

VIII. Authorized Official

Name: SHELBY SINGLETON
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 970-322-4856