Fairacres Manor, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

020369 Issued in CO

Legal business name

FAIRACRES MANOR, INC

Doing business as

Fairacres Manor

Practice address

1700 18TH Ave
Greeley, CO 80631-5134

Phone

(970) 353-3370

Fax

(970) 353-9347

NPI assigned

Nov 5, 2015

Last updated

Jan 9, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Koretke

Title

Director of Reimbursement

Phone

(720) 974-6278

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fairacres Manor Doing business as

Tax ID family

Fairacres Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fairacres Manor, Inc

  dba Fairacres Manor

  • Skilled Nursing Facility
  • Greeley, CO
  • NPI 1154300853
  NPD tax ID

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1205209764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 18TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806315134",
            "telephone_number": "970-353-3370",
            "fax_number": "970-353-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 18TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806315134",
            "telephone_number": "970-353-3370",
            "fax_number": "970-353-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRACRES MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-05",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "KORETKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "720-974-6278"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "020369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4139994",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairacres Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Face Down Medical Equipment, LLC
• Kathleen Rose Fahey, PH.D., CCC-ALP
• Herbert Daniel Fahrenholtz, MD
• Elise S Fair, MA, LPC
• Fairacres Manor, Inc (Fairacres Manor)
• Sandra L Fairbanks, MA
• Brittany Fairchild, BSW
• Family Dental and Specialists of Greeley (Associates in Family Dentistry and Specialists of Greely)
• Family Physicians of Greeley
• Family Physicians of Greeley

• Skilled Nursing Facility in Greeley, CO
• Providers in Greeley, CO by specialty
• Skilled Nursing Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.