Provider Demographics
NPI:1780055905
Name:COLOROW HEALTH CARE, LLC
Entity type:Organization
Organization Name:COLOROW HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
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:720-974-6278
Mailing Address - Street 1:885 S HIGHWAY 50 BUSINESS LOOP
Mailing Address - Street 2:PO BOX 710
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-1536
Mailing Address - Country:US
Mailing Address - Phone:970-323-5504
Mailing Address - Fax:970-323-6031
Practice Address - Street 1:885 S HIGHWAY 50 BUSINESS LOOP
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425-1536
Practice Address - Country:US
Practice Address - Phone:970-323-5504
Practice Address - Fax:970-323-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO021154314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04142527Medicaid