Provider Demographics
NPI:1922330158
Name:ORCHARD PARK NURCING AND REHAB
Entity Type:Organization
Organization Name:ORCHARD PARK NURCING AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:T
Authorized Official - Last Name:COUSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-435-4044
Mailing Address - Street 1:2217 CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2338
Mailing Address - Country:US
Mailing Address - Phone:720-435-4044
Mailing Address - Fax:
Practice Address - Street 1:2217 CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2338
Practice Address - Country:US
Practice Address - Phone:720-435-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-14
Last Update Date:2010-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043282311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home