Provider Demographics
NPI:1962493809
Name:BUCKEYE A, LLC
Entity Type:Organization
Organization Name:BUCKEYE A, LLC
Other - Org Name:AUTUMN HEIGHTS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:303-238-3838
Mailing Address - Street 1:12136 W. BAYAUD AVENUE
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:303-238-3838
Mailing Address - Fax:303-987-0434
Practice Address - Street 1:3131 S. FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-2713
Practice Address - Country:US
Practice Address - Phone:303-761-0260
Practice Address - Fax:303-761-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0318314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05656004Medicaid
065191Medicare Oscar/Certification
CO0359660010Medicare NSC