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NPI Code Detail

MEDICARE: SKIN HDC

MEDICARE: SKIN HDC
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 Facility0100256CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112767902OTHERCAQH

General Provider Information

NPI Number : 1417334806
Entity Type Code : Organization
Provider Name (Legal Business Name) : SKIN HDC
Provider Business Mailing Address
First Line : 413 SUMMIT BLVD
Second Line : UNIT 104
City : BROOMFIELD
State : CO
Zip : 80021-8294
Country : US
Telephone Number : 303-440-6611
Fax Number : 720-550-8995
Provider Business Practice Location Address
First Line : 413 SUMMIT BLVD
Second Line : UNIT 104
City : BROOMFIELD
State : CO
Zip : 80021-8294
Country : US
Telephone Number : 303-440-6611
Fax Number : 720-550-8995
Authorized Official
Title or Position : REGISTERED NURSE, CEO
Name : GYWNN WOLFSTAR
Credential : RN, BSN, BA
Telephone Number : 303-440-6611
Provider Enumeration Date : 05/05/2015
Last Update Date : 05/05/2015

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Directions to “SKIN HDC ” Practice Location

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