=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417813015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GM 465 BURLINGTON OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2025
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 465 5TH ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80807-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-346-7512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2668 NORTHPARK DR
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80026-3199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-952-9216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF MEMBER
-----------------------------------------------------
Name | STEVEN VELUSCEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-952-9216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------