Organization
PINE RIDGE EXTENDED CARE CENTER, LLC
Active
Other names
Pine Ridge Extended Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BROOKS (ADMINISTRATOR)
(970) 731-4330
Entity
Organization
Contact information
Practice address
119 BASTILLE DR, PAGOSA SPRINGS, CO 81147-9388
(970) 731-4330
(970) 731-4046
Mailing address
119 BASTILLE DR, PAGOSA SPRINGS, CO 81147-9388
(970) 731-4330
(970) 731-4046
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
0105
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04183539
—
CO
Enumeration date
01/02/2007
Last updated
08/22/2020
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