Provider Demographics
NPI:1053310839
Name:RENOTTA HEALTH CARE SYSTEMS, INC
Entity Type:Organization
Organization Name:RENOTTA HEALTH CARE SYSTEMS, INC
Other - Org Name:HILLCREST CARE CENTER / THE TOWERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:970-322-4856
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:360 CANYON RIDGE DR.
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-0100
Mailing Address - Country:US
Mailing Address - Phone:970-332-4856
Mailing Address - Fax:970-332-4882
Practice Address - Street 1:360 CANYON RIDGE DR
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-8947
Practice Address - Country:US
Practice Address - Phone:970-332-4856
Practice Address - Fax:970-332-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-842310400000X
CO0668314000000X
CO94871868385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73953377Medicaid
CO94871868Medicaid
CO14624371Medicaid
CO94871868Medicaid