Pine Ridge Extend Care Center, LLC
Skilled Nursing Facility in Pagosa Springs, CO. Organization (NPI-2).
NPI number1245237494
StatusActive
Last updated in NPPESOct 6, 2015
Details
- NPI
- 1245237494
- Entity type
- Organization (NPI-2)
- Legal business name
- Pine Ridge Extend Care Center, LLC
- Organization subpart
- No
- Enumeration date
- Jul 1, 2005
- Last updated
- Oct 6, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | 0105 | CO | Yes |
Practice location
119 Bastille DrPagosa Springs, CO 81147-9388
Phone 970-731-4330 · Fax 970-731-4046
Mailing address
119 Bastille DrPagosa Springs, CO 81147-9388
Phone 970-731-4330 · Fax 970-731-4046
Authorized official
Mary J. Brooks
Nursing Home Administrator
9707314330
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