Provider Demographics
NPI:1356415442
Name:ST FRANCIS NURSING CENTER
Entity type:Organization
Organization Name:ST FRANCIS NURSING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:719-598-1336
Mailing Address - Street 1:7550 ASSISI HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-598-1336
Mailing Address - Fax:719-598-6472
Practice Address - Street 1:7550 ASSISI HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3853
Practice Address - Country:US
Practice Address - Phone:719-598-1336
Practice Address - Fax:719-598-6472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS NURSING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0984314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05651906Medicaid
CO04140612Medicaid
CO05650734Medicaid
CO9805693OtherTAX EXEMPT
CO065325Medicare ID - Type UnspecifiedPROVIDER NUMBER