Provider Demographics
NPI:1679552301
Name:CAMELOT HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CAMELOT HEALTH CARE, INC.
Other - Org Name:VALLEY VIEW HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORETKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-987-3088
Mailing Address - Street 1:12136 W BAYAUD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2115
Mailing Address - Country:US
Mailing Address - Phone:303-987-3088
Mailing Address - Fax:303-987-0434
Practice Address - Street 1:2120 N 10TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2211
Practice Address - Country:US
Practice Address - Phone:719-275-7569
Practice Address - Fax:719-275-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO392314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05651468Medicaid
CO05651468Medicaid