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NPI Code Detail

MEDICARE: CENTRE AVENUE HEALTH & REHAB FACILITY LLC

MEDICARE: CENTRE AVENUE HEALTH & REHAB FACILITY LLC
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 Facility0434CO

General Provider Information

NPI Number : 1194719872
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRE AVENUE HEALTH & REHAB FACILITY LLC
Provider Business Mailing Address
First Line : 815 CENTRE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1844
Country : US
Telephone Number : 970-494-2140
Fax Number : 970-494-2141
Provider Business Practice Location Address
First Line : 815 CENTRE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1844
Country : US
Telephone Number : 970-494-2140
Fax Number : 970-494-2141
Authorized Official
Title or Position : CFO
Name : MR. BARRY KENT FANCHER
Credential :
Telephone Number : 970-482-0198
Provider Enumeration Date : 09/08/2005
Last Update Date : 08/19/2013

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Directions to “CENTRE AVENUE HEALTH & REHAB FACILITY LLC ” Practice Location

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