Provider Demographics
NPI:1629287172
Name:RURAL REST HOMES LLC
Entity Type:Organization
Organization Name:RURAL REST HOMES LLC
Other - Org Name:TENDER CARE VILLAGE OF FLAGER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-4039
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547
Mailing Address - Country:US
Mailing Address - Phone:970-481-8902
Mailing Address - Fax:866-881-2537
Practice Address - Street 1:419 PAWNEE
Practice Address - Street 2:
Practice Address - City:FLAGER
Practice Address - State:CO
Practice Address - Zip Code:80815
Practice Address - Country:US
Practice Address - Phone:719-765-4442
Practice Address - Fax:719-765-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL0424310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38000393Medicaid