MEDICARE: LOVELAND ELDER GREEN HOUSE HOMES FOR LIFE ENHANCEMENT

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	02F496	CO

General Provider Information

NPI Number	:	1932564994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVELAND ELDER GREEN HOUSE HOMES FOR LIFE ENHANCEMENT

Provider Business Mailing Address
First Line	:	490 MIRASOL DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-2339
Country	:	US
Telephone Number	:	970-342-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 MIRASOL DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-2339
Country	:	US
Telephone Number	:	970-342-2400
Fax Number	:	970-342-2267

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MARY KORETKE
Credential	:
Telephone Number	:	720-974-6278

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/23/2021

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