PINE RIDGE EXTENDED CARE CENTER NPI 1922005644

NPI Information

NPI: 1922005644
Provider Name: PINE RIDGE EXTENDED CARE CENTER
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
119 BASTILLE DR
PAGOSA SPRINGS, CO
ZIP 81147
Phone: (970) 731-4330
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PINE RIDGE EXTENDED CARE CENTER is an assisted living facility in Pagosa Springs, CO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PINE RIDGE EXTENDED CARE CENTER NPI is 1922005644. The provider is registered as an organization entity type.

The provider's business location address is:

119 BASTILLE DR
PAGOSA SPRINGS, CO
ZIP 81147-388
Phone: (970) 731-4330
Fax: (970) 731-4046

The provider's authorized official is Mary J Brooks .
The authorized official title is Nusing Home Administrator and has the following contact phone number (970) 731-4330.

The enumeration date for this NPI number is 7/7/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		AL0228	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04143434	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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