Provider Demographics
NPI:1417533548
Name:RE II SENIOR III OPCO LLC
Entity Type:Organization
Organization Name:RE II SENIOR III OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORETKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-378-8320
Mailing Address - Street 1:4255 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5545
Mailing Address - Country:US
Mailing Address - Phone:702-732-0652
Mailing Address - Fax:702-732-9520
Practice Address - Street 1:4255 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5545
Practice Address - Country:US
Practice Address - Phone:702-732-0652
Practice Address - Fax:702-732-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility