Basic Information
| Provider Information | |||||||||
| NPI: | 1780055905 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLOROW HEALTH CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLOROW CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 885 S HIGHWAY 50 BUSINESS LOOP | ||||||||
| Address2: | PO BOX 710 | ||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814251536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703235504 | ||||||||
| FaxNumber: | 9703236031 | ||||||||
| Practice Location | |||||||||
| Address1: | 885 S HIGHWAY 50 BUSINESS LOOP | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814251536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703235504 | ||||||||
| FaxNumber: | 9703236031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | KORETKE | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7209746278 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 021154 | CO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 04142527 | 05 | CO | MEDICAID |