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NPI Code Detail

MEDICARE: PINE RIDGE EXTENDED CARE CENTER

MEDICARE: PINE RIDGE EXTENDED CARE 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
1310400000XAssisted Living FacilityAL0228CO

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 : 1922005644
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE RIDGE EXTENDED CARE CENTER
Provider Business Mailing Address
First Line : 119 BASTILLE DR
Second Line :
City : PAGOSA SPRINGS
State : CO
Zip : 81147-9388
Country : US
Telephone Number : 970-731-4330
Fax Number : 970-731-4046
Provider Business Practice Location Address
First Line : 119 BASTILLE DR
Second Line :
City : PAGOSA SPRINGS
State : CO
Zip : 81147-9388
Country : US
Telephone Number : 970-731-4330
Fax Number : 970-731-4046
Authorized Official
Title or Position : NUSING HOME ADMINISTRATOR
Name : MS. MARY J BROOKS
Credential : RN
Telephone Number : 970-731-4330
Provider Enumeration Date : 07/07/2005
Last Update Date : 08/22/2020

Similar Medicare Providers

1245237494 — PINE RIDGE EXTEND CARE CENTER, LLC
Practice Location Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
81147-9388
Practice Phone: 970-731-4330
Practice Fax: 970-731-4046
1336206010 — PINE RIDGE EXTENDED CARE CENTER, LLC
Practice Location Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
81147-9388
Practice Phone: 970-731-4330
Practice Fax: 970-731-4046
1558685792 — ERICA J ROBINSON
Practice Location Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
81147-9388
Practice Phone: 970-731-4330
Practice Fax:
1306161146 — MRS. KRISTIN RENEE OVENSHIRE MOREHOUSE MSOT. MED
Practice Location Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
81147-9388
Practice Phone: 970-731-4041
Practice Fax:
1700102183 — PATRICIA VORHIES COTA
Practice Location Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
81147-9388
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Practice Fax:
1336451236 — STEPHANIE LYNN PHAM MS CCC-SLP
Practice Location Address:
701 CAMINO DEL RIO SUITE 221
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81147-9388
Practice Phone: 970-247-3261
Practice Fax:

Directions to “PINE RIDGE EXTENDED CARE CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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