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General NPI Number Information
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NPI Number | 1932564994
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Entity Type | Organization
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Legal Business Name | LOVELAND ELDER GREEN HOUSE HOMES FOR LIFE ENHANCEMENT
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 490 MIRASOL DR
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City | LOVELAND
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State | CO
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Zip | 80537-2339
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Country | US
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Telephone | 970-342-2400
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Fax | 970-342-2267
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Provider Business Mailing Address
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Address Line | 490 MIRASOL DR
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City | LOVELAND
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State | CO
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Zip | 80537-2339
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Country | US
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Telephone | 970-342-2400
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | MARY KORETKE
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Credential |
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Telephone | 720-974-6278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 02F496
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License Number State | CO
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