Provider Demographics
NPI:1134640998
Name:MERE, THERESA A (SNF)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:MERE
Suffix:
Gender:F
Credentials:SNF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8232
Mailing Address - Country:US
Mailing Address - Phone:325-691-5519
Mailing Address - Fax:325-698-4582
Practice Address - Street 1:2670 S ABILENE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2336
Practice Address - Country:US
Practice Address - Phone:303-695-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6609311500000X
OKNH6603-6603311Z00000X
3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1457786303Medicaid
OK1184059982Medicaid
CO1578832226Medicaid