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NPI Code Detail

MEDICARE: CLEAR CREEK CENTERS, INC

MEDICARE: CLEAR CREEK CENTERS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility021154CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194184614
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEAR CREEK CENTERS, INC
Provider Business Mailing Address
First Line : 7481 KNOX PL
Second Line :
City : WESTMINSTER
State : CO
Zip : 80030-4818
Country : US
Telephone Number : 303-427-7101
Fax Number : 303-427-8384
Provider Business Practice Location Address
First Line : 7481 KNOX PL
Second Line :
City : WESTMINSTER
State : CO
Zip : 80030-4818
Country : US
Telephone Number : 303-427-7101
Fax Number : 303-427-8384
Authorized Official
Title or Position : DIRECTOR OF REIMBURSEMENT
Name : MARY KORETKE
Credential :
Telephone Number : 720-974-6278
Provider Enumeration Date : 02/11/2016
Last Update Date : 02/11/2016

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1740033737 — CLEAR CREEK CARE CENTER LLC
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80030-4818
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Directions to “CLEAR CREEK CENTERS, INC ” Practice Location

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