Provider Demographics
NPI:1700418191
Name:RED OAK REHABILITATION AND CARE COMMUNITY, LLC
Entity Type:Organization
Organization Name:RED OAK REHABILITATION AND CARE COMMUNITY, 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:303-238-3838
Mailing Address - Street 1:12136 W BAYAUD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2115
Mailing Address - Country:US
Mailing Address - Phone:303-238-3838
Mailing Address - Fax:
Practice Address - Street 1:816 S INTEROCEAN AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-2120
Practice Address - Country:US
Practice Address - Phone:970-854-2251
Practice Address - Fax:970-854-2610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED OAK REHABILITATION AND CARE COMMUNITY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility