Organization
EAGLE RIDGE OPERATING COMPANY, LLC
Active
Other names
EAGLE RIDGE AT GRAND VALLEY
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KORETKE (DIRECTOR OF REIMBURSEMENT)
(720) 974-6278
Entity
Organization
Contact information
Practice address
2425 TELLER AVE, GRAND JUNCTION, CO 81501-5141
(970) 243-3381
(970) 243-3416
Mailing address
12136 W. BAYAUD AVENUE, SUITE 200, LAKEWOOD, CO 80228
(720) 974-6278
(303) 987-0434
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
021116
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300-86863
—
CO
05
—
417-081058
—
CO
Enumeration date
09/27/2006
Last updated
07/18/2022
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