Provider Demographics
NPI:1922000371
Name:PITMAN PLACE, LLC
Entity Type:Organization
Organization Name:PITMAN PLACE, LLC
Other - Org Name:HORIZON HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-238-3838
Mailing Address - Street 1:1610 SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2676
Mailing Address - Country:US
Mailing Address - Phone:719-564-0550
Mailing Address - Fax:719-561-1601
Practice Address - Street 1:1610 SCRANTON AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2676
Practice Address - Country:US
Practice Address - Phone:719-564-0550
Practice Address - Fax:719-561-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0275314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652672Medicaid
065236Medicare Oscar/Certification