NPIMap

Organization Active NPI

12080 Bellaire Way Operations LLC

Doing business as Elms Haven Center

  • Skilled Nursing Facility
  • Thornton, CO
National Provider Identifier
1013967132
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0247 Issued in CO
Legal business name
12080 BELLAIRE WAY OPERATIONS LLC
Doing business as
Elms Haven Center
Practice address
12080 Bellaire Way
Thornton, CO 80241-3600
Phone
(303) 450-2700
Fax
(303) 450-2800
NPI assigned
May 11, 2006
Last updated
Nov 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNBRIDGE HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael T Berg
Title
Authorized Official
Phone
(505) 468-4742

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0247 CO Primary

Addresses

Primary practice location

12080 Bellaire Way
Thornton, CO 80241-3600

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 5

IdentifierTypeStateIssuer
7100494OtherCOEVERCARE
05652961MedicaidCO
522089013OtherCOSECURE HORIZONS
522089013OtherCOROCKY MTN HMO
52208901301OtherCOCOLORADO ACCESS

Other names 1

  • Elms Haven Center Doing business as

National Provider Directory

National Provider Directory
Part of
Sunrise HLTH Care Corp

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636329600000",
    "number": "1013967132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12080 BELLAIRE WAY",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802413600",
            "telephone_number": "303-450-2700",
            "fax_number": "303-450-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12080 BELLAIRE WAY OPERATIONS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE LLC",
        "enumeration_date": "2006-05-11",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "0247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "7100494",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05652961",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURE HORIZONS",
            "identifier": "522089013",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCKY MTN HMO",
            "identifier": "522089013",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO ACCESS",
            "identifier": "52208901301",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elms Haven Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elms Haven Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.