Organization
7395 W EASTMAN PLACE OPERATIONS LLC
Active
Parent organization
GENESIS CO HOLDINGS LLC
Other names
PowerBack Rehabilitation Lakewood
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS CO HOLDINGS LLC
Authorized official
MICHAEL THEODORE BERG JD (VP ASST SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
7395 W EASTMAN PL, LAKEWOOD, CO 80227-5006
(303) 730-8000
Mailing address
7395 W EASTMAN PL, LAKEWOOD, CO 80227-5006
(303) 730-8000
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06540
MEDICARE
CO
01
—
158889676
SNF NPI
CO
Enumeration date
03/16/2020
Last updated
03/16/2020
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