Organization
1111 BONFORTE OPCO LLC
Active
Parent organization
1111 BONFORTE OPCO LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
1111 BONFORTE OPCO LLC
Authorized official
DEAN KIKLIS (CFO)
(303) 952-9216
Entity
Organization
Contact information
Practice address
855 HUNTER DR., PUEBLO, CO 81001
(719) 545-5911
Mailing address
855 HUNTER DR., PUEBLO, CO 81001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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