Provider Demographics
NPI:1598176828
Name:LOVELAND ELDER GREEN HOUSE HOMES FOR LIFE ENRICHMENT A COLORADO NON
Entity Type:Organization
Organization Name:LOVELAND ELDER GREEN HOUSE HOMES FOR LIFE ENRICHMENT A COLORADO NON
Other - Org Name:THE GREEN HOUSE HOMES AT MIRASOL
Other - Org Type:Doing Business As
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:720-974-6278
Mailing Address - Street 1:490 MIRASOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-2530
Mailing Address - Country:US
Mailing Address - Phone:970-342-2400
Mailing Address - Fax:
Practice Address - Street 1:490 MIRASOL DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-2339
Practice Address - Country:US
Practice Address - Phone:970-342-2400
Practice Address - Fax:970-342-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08603855Medicaid
CO08603855Medicaid