MEDICARE: WHEAT RIDGE REGIONAL CENTER

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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1275779548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEAT RIDGE REGIONAL CENTER

Provider Business Mailing Address
First Line	:	10285 RIDGE RD
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-2301
Country	:	US
Telephone Number	:	303-463-2500
Fax Number	:	303-463-2501

Provider Business Practice Location Address
First Line	:	5340 PERRY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-4032
Country	:	US
Telephone Number	:	303-433-6048
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR WHEAT RIDGE REGIONAL CNTR
Name	:	JOELLE HENAO
Credential	:
Telephone Number	:	303-463-2657

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	07/26/2021

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