MEDICARE: CENTER AT ROCK CREEK, 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
1	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1609410380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER AT ROCK CREEK, LLC

Provider Business Mailing Address
First Line	:	4880 ZIEGLER RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9007
Country	:	US
Telephone Number	:	970-223-4376
Fax Number	:	970-223-1784

Provider Business Practice Location Address
First Line	:	4880 ZIEGLER RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9007
Country	:	US
Telephone Number	:	970-223-4376
Fax Number	:	970-223-1784

Authorized Official
Title or Position	:	MANAGER
Name	:	MONTE MURDOCK
Credential	:
Telephone Number	:	719-900-1398

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	04/03/2020

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