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NPI Code Detail

MEDICARE: RED OAK REHABILITATION AND CARE COMMUNITY, LLC

MEDICARE: RED OAK REHABILITATION AND CARE COMMUNITY, 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1700418191
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED OAK REHABILITATION AND CARE COMMUNITY, LLC
Provider Business Mailing Address
First Line : 12136 W BAYAUD AVE STE 200
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-2115
Country : US
Telephone Number : 303-238-3838
Fax Number :
Provider Business Practice Location Address
First Line : 816 S INTEROCEAN AVE
Second Line :
City : HOLYOKE
State : CO
Zip : 80734-2120
Country : US
Telephone Number : 970-854-2251
Fax Number : 970-854-2610
Authorized Official
Title or Position : DIRECTOR OF REIMBURSEMENT
Name : MARY KORETKE
Credential :
Telephone Number : 303-238-3838
Provider Enumeration Date : 02/04/2020
Last Update Date : 02/04/2020

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Directions to “RED OAK REHABILITATION AND CARE COMMUNITY, LLC ” Practice Location

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