=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801104195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERICARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2010
-----------------------------------------------------
Last Update Date | 06/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12791 W ALAMEDA PKWY
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80228-2838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-237-5700
-----------------------------------------------------
Fax | 303-237-5850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6737 W WASHINGTON ST SUITE 2300
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CFO
-----------------------------------------------------
Name | MARK OHLENDORF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-918-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------