Provider Demographics
NPI:1225401490
Name:THE RESIDENCE AT OAKRIDGE, LLC
Entity Type:Organization
Organization Name:THE RESIDENCE AT OAKRIDGE, LLC
Other - Org Name:RESIDENCE AT OAKRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:305-444-5007
Mailing Address - Street 1:4750 WHEATON DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9481
Mailing Address - Country:US
Mailing Address - Phone:970-229-5800
Mailing Address - Fax:
Practice Address - Street 1:4750 WHEATON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9481
Practice Address - Country:US
Practice Address - Phone:970-229-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R289310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24808831Medicaid