MEDICARE: COLUMBINE CARE CENTER WEST INC.

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	314000000X	Skilled Nursing Facility	1026	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932178985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBINE CARE CENTER WEST INC.

Provider Business Mailing Address
First Line	:	940 WORTHINGTON CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1840
Country	:	US
Telephone Number	:	970-221-9156
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 WORTHINGTON CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1840
Country	:	US
Telephone Number	:	970-221-2273
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOY WINNER
Credential	:
Telephone Number	:	970-221-2273

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/14/2008

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