NPIMap

Organization Active NPI

La Junta Health Service District

  • Skilled Nursing Facility
  • La Junta, CO
National Provider Identifier
1053956268
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LA JUNTA HEALTH SERVICE DISTRICT
Practice address
1 Darlene Drive
La Junta, CO 81050
Phone
(719) 363-1700
Fax
(303) 987-0434
NPI assigned
Nov 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Mary Koretke
Title
Director, Cost Reporting
Phone
(720) 974-6278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1 Darlene Drive
La Junta, CO 81050

Mailing address

1 Darlene Drive
La Junta, CO 81050
Phone (719) 363-1700

Other identifiers 1

IdentifierTypeStateIssuer
9000238087MedicaidCO

Other names 1

  • Bluestem Village Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231020001088 CO Part A Provider - Skilled Nursing Facility 8921454307 Practice locations: La Junta, CO

Skilled nursing facility certification: CCN 065436

Legal name
LA JUNTA HEALTH SERVICE DISTRICT
Doing business as
BLUESTEM VILLAGE
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Sep 13, 2024
Last certification
Sep 5, 2024
Beds
56
Ownership / control type
State
Organization structure
GovernmentNon-profit
Incorporated
Aug 21, 2019 in CO
Enrollment address
1 Darlene Dr
La Junta, CO 81050-9209
Nursing home name
BLUESTEM VILLAGE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bluestem VillageCCN 065436
Type
Medicare
Ownership
Government - State
Certified
Sep 13, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5631.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2289969La Junta Health Service District1 Darlene Drive, La Junta, CO 81050Certificate of waiverSep 18, 2027

National Provider Directory

National Provider Directory

Locations

1 Darlene Dr
La Junta, CO 81050
Phone (719) 636-1700

1904 San Juan Ave
Rm 111
La Junta, CO 81050

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karla Valle Individual Adp of the SNF Jan 15, 2025
John D Brammeier Individual Operational/Managerial Control Jan 10, 2025
Managing Control - Governing BodyCfo Mar 1, 2012
Adp of the SNF Jan 16, 2025
Mary E Koretke Individual Operational/Managerial Control Dec 31, 2024
Johnnie Deleon Individual Operational/Managerial Control Dec 31, 2024
Managing Control - Governing BodyPresident/Chairman of Board Nov 7, 2017
Jeannae Dergance Individual Adp of the SNF Dec 31, 2024
Melodie Sedillo Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
Jay H Moskowitz Individual Corporate OfficerCeo, QP Healthcare Services Apr 15, 2018 82%
Operational/Managerial Control Jun 15, 2021
Adp of the SNF Jun 15, 2021
Diane Fowler Individual 5% Or Greater Security Interest Nov 7, 2017
Managing Control - Governing BodyBoard Secretary Nov 7, 2017
QP Health Care Services LLC Organization, Gendale, CO LLC, Management services company, Consulting firm Operational/Managerial Control Dec 16, 2024
Adp of the SNF Jan 10, 2025
Cynthia Haskell Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
Chaim M Raskin Individual Adp of the SNF Jan 15, 2025
La Junta Health Service District Organization, La Junta, CO Created for acquisition 5% Or Greater Direct Ownership Interest Dec 11, 2017 100%
5% Or Greater Mortgage Interest Dec 11, 2017 100%
Operational/Managerial Control Dec 16, 2024
Adp of the SNF Dec 16, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1053956268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DARLENE DRIVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "81050",
            "telephone_number": "719-363-1700",
            "fax_number": "303-987-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DARLENE DRIVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "81050",
            "telephone_number": "719-363-1700",
            "fax_number": "303-987-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA JUNTA HEALTH SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "KORETKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR, COST REPORTING",
        "authorized_official_telephone_number": "720-974-6278"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000238087",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluestem Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Junta, CO

Sources for this page

Verify at the official NPI Registry.