Provider Demographics
NPI:1629090725
Name:SUNCREST HOSPICE - NOCO, LLC
Entity Type:Organization
Organization Name:SUNCREST HOSPICE - NOCO, LLC
Other - Org Name:WLH, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE VP/CFP
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-433-0932
Mailing Address - Street 1:206 N 2100 W STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4741
Mailing Address - Country:US
Mailing Address - Phone:801-656-2769
Mailing Address - Fax:303-957-3113
Practice Address - Street 1:3770 PURITAN WAY UNIT E
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80516-9463
Practice Address - Country:US
Practice Address - Phone:303-957-3101
Practice Address - Fax:303-957-3113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0081251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21486271Medicaid
CO061561Medicare PIN