NPIMap

Organization Active NPI

1111 Bonforte Opco, LLC

Doing business as The Pavilion at Villa Pueblo

  • Skilled Nursing Facility
  • Pueblo, CO
National Provider Identifier
1285060756
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
1111 BONFORTE OPCO, LLC
Doing business as
The Pavilion at Villa Pueblo
Practice address
855 Hunter Dr
Pueblo, CO 81001-1867
Phone
(719) 545-5911
Fax
(719) 253-3709
NPI assigned
Sep 17, 2013
Last updated
Sep 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Authorized official

Name
Dean Kiklis
Title
Cfo
Phone
(303) 952-9216

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

855 Hunter Dr
Pueblo, CO 81001-1867

Mailing address

2668 Northpark Dr
Suite 220
Lafayette, CO 80026-3199
Phone (303) 952-9216

Other names 1

  • The Pavilion at Villa Pueblo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131231001681 CO Part A Provider - Skilled Nursing Facility 3072741784 Practice locations: Pueblo, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285060756. Details of each certification follow.

Skilled nursing facility certification: CCN 065121

Legal name
1111 BONFORTE OPCO, LLC
Doing business as
THE PAVILION AT VILLA PUEBLO
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 30, 1973
Last certification
Dec 14, 2023
Beds
90
Ownership / control type
Corporation
Multi-facility organization
Frontline Management
Organization structure
LLCProprietary
Incorporated
Aug 13, 2013 in CO
Enrollment address
The Pavilion at Villa Pueblo
855 Hunter Drive
Pueblo, CO 81001-1867
Nursing home name
VISTA RIDGE CARE AND REHABILITATION
Affiliated entity
FRONTLINE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vista Ridge Care and RehabilitationCCN 065121 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 30, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9069.1 residents per day on average
Chain
Frontline Management9 facilities in the chain
Penalties (3 years)
3Fines totaling $41,772

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
1111 Bonforte Opco LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 34

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

NameRoleSinceShare
Diana Coulson Individual Operational/Managerial Control Mar 2, 1979
Adp of the SNF Mar 2, 1979
Robert Jones Individual Operational/Managerial Control Nov 1, 2013
Adp of the SNF Nov 1, 2013
Indirect Ownership Interest Nov 1, 2013 2.5%
Tammy Simmerville Individual Operational/Managerial Control Nov 2, 1974
Adp of the SNF Nov 2, 1974
Quality Care Rehab Inc Organization, Homosassa, FL Corporation Operational/Managerial Control Mar 1, 2024
Adp of the SNF Jul 9, 2025
Deborah Babich Individual Operational/Managerial Control Jun 15, 2025
Adp of the SNF Jun 15, 2025
Kelly Saracino Individual Operational/Managerial Control Nov 1, 2013
Adp of the SNF Nov 1, 2013
Frontier Management Inc Organization, Lafayette, CO Corporation, Management services company, Chain home office Operational/Managerial Control Nov 1, 2013
Adp of the SNF Jul 14, 2025
Amy Lopez Individual Operational/Managerial Control Apr 29, 2025
Adp of the SNF Apr 29, 2025
Heather Orback Individual Operational/Managerial Control Nov 1, 2023
Adp of the SNF Nov 1, 2013
Indirect Ownership Interest Nov 1, 2013 2.5%
Marcy Slyhoff Individual Operational/Managerial Control Jan 16, 2015
Adp of the SNF Jan 16, 2015
Gregory Allen Falk Individual 5% Or Greater Indirect Ownership Interest Nov 1, 2013 50%
Michelle Newton Individual Operational/Managerial Control Dec 26, 2017
Adp of the SNF Dec 26, 2017
1111 Bonforte Blvd, LLC Organization, Lafayette, CO Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Nov 1, 2013 100%
Wipfli LLP Organization, Saint Charles, MO Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jul 9, 2025
Clarinda Chavez Individual Operational/Managerial Control Oct 21, 2024
Adp of the SNF Oct 21, 2024
Moreblessing Nyaradzo Sipiriano Individual Operational/Managerial Control May 20, 2025
Adp of the SNF May 20, 2025
Daniel Gerson Individual Operational/Managerial Control Dec 17, 2018
Adp of the SNF Dec 17, 2018
Remedi Seniorcare of Colorado, LLC Organization, Towson, MD LLC Operational/Managerial Control May 31, 2019
Adp of the SNF Jul 9, 2025
Adam Baker Individual Operational/Managerial Control Apr 16, 2020
Adp of the SNF Apr 16, 2020
Dean Kiklis Individual Indirect Ownership Interest Nov 1, 2013 2.5%
Jeremy Duran Individual Operational/Managerial Control Apr 24, 2023
Adp of the SNF Apr 23, 2023
Angela Connor Individual Operational/Managerial Control Nov 18, 2024
Adp of the SNF Nov 18, 2024
Tammy Dubla Individual Operational/Managerial Control Feb 26, 2024
Adp of the SNF Feb 26, 2024
Vikas Thouti Reddy Individual Operational/Managerial Control Dec 4, 2024
Adp of the SNF Dec 4, 2024
Edison Ong Individual Operational/Managerial Control Apr 4, 2025
Adp of the SNF Apr 4, 2025
Belen Gray-Trujillo Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Fmi-VP, LLC Organization, Lafayette, CO LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 1, 2013 50%
Cibc Bank USA Organization, Chicago, IL Created for acquisition, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Nov 1, 2013 100%
Cherise Salas Individual Operational/Managerial Control Jun 2, 2014
Adp of the SNF Jun 2, 2014
Steven W Veluscek Individual 5% Or Greater Indirect Ownership Interest Nov 1, 2013 42.5%
Integra Accounting Solutions LLC Organization, Wichita, KS LLC Adp of the SNF Jan 1, 2025
Susan Daberkow Individual Operational/Managerial Control Jun 10, 2024
Adp of the SNF Jun 10, 2024
Adriene Vialpando Individual Operational/Managerial Control Sep 2, 2024
Adp of the SNF Sep 2, 2024
Lippold & Holland LLC Organization, Keizer, OR LLC Adp of the SNF Nov 25, 2020

Owners & managing parties with NPI records 2

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

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1285060756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2668 NORTHPARK DR",
            "address_2": "SUITE 220",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800263199",
            "telephone_number": "303-952-9216",
            "fax_number": "303-675-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 HUNTER DR",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011867",
            "telephone_number": "719-545-5911",
            "fax_number": "719-253-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1111 BONFORTE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2013-09-26",
        "status": "A",
        "authorized_official_last_name": "KIKLIS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-952-9216"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at Villa Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.