Basic Information
| Provider Information | |||||||||
| NPI: | 1023512613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARKMOOR VILLAGE HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12136 W BAYAUD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802282115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032383838 | ||||||||
| FaxNumber: | 3039870434 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 PARKMOOR VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809175205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195500200 | ||||||||
| FaxNumber: | 7196370756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | KORETKE | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7209746278 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 020542 | CO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.