Basic Information
| Provider Information | |||||||||
| NPI: | 1700418191 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED OAK REHABILITATION AND CARE COMMUNITY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12136 W BAYAUD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802282115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032383838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 816 S INTEROCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807342120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708542251 | ||||||||
| FaxNumber: | 9708542610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | KORETKE | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 3032383838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RED OAK REHABILITATION AND CARE COMMUNITY, LLC | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.