Provider Demographics
NPI:1215640644
Name:290 SOUTH MONACO PARKWAY OPERATIONS LLC
Entity type:Organization
Organization Name:290 SOUTH MONACO PARKWAY OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:290 S MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1105
Mailing Address - Country:US
Mailing Address - Phone:303-355-3525
Mailing Address - Fax:
Practice Address - Street 1:290 S MONACO PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1105
Practice Address - Country:US
Practice Address - Phone:303-355-3525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS PM CO OPERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility