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General NPI Number Information
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NPI Number | 1992796874
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Entity Type | Organization
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Legal Business Name | BUCKEYE C, LLC
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 2311 E BRIDGE STREET
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City | BRIGHTON
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State | CO
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Zip | 80601-2547
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Country | US
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Telephone | 303-659-2253
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Fax | 303-659-6334
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Provider Business Mailing Address
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Address Line | 12136 W. BAYAUD AVENUE SUITE 200
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City | LAKEWOOD
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State | CO
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Zip | 80228-2115
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Country | US
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Telephone | 303-238-3838
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Fax | 303-987-0434
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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 | 020312
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License Number State | CO
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