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NPI Code Detail

MEDICARE: BROOMFIELD SKILLED NURSING AND REHABILITATION CENTER, LLC

MEDICARE: BROOMFIELD SKILLED NURSING AND REHABILITATION CENTER, 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 Facility0030CO

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 : 1376540583
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOMFIELD SKILLED NURSING AND REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 12975 SHERIDAN BLVD
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-1477
Country : US
Telephone Number : 303-785-5800
Fax Number : 303-785-5801
Provider Business Practice Location Address
First Line : 12975 SHERIDAN BLVD
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-1477
Country : US
Telephone Number : 303-785-5800
Fax Number : 303-785-5801
Authorized Official
Title or Position : PRESIDENT
Name : GLENN LEFKOVITZ
Credential :
Telephone Number : 847-412-8791
Provider Enumeration Date : 07/01/2005
Last Update Date : 09/20/2017

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