Organization Active NPI

Poncha Moor Healthcare, Inc

Doing business as Skyline Ridge Health and Rehabilitation

  • Respite Care
  • Canon City, CO
National Provider Identifier
1366346256
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
Legal business name
PONCHA MOOR HEALTHCARE, INC
Doing business as
Skyline Ridge Health and Rehabilitation
Practice address
515 Fairview Ave
Canon City, CO 81212-2863
Phone
(719) 275-0665
Fax
(719) 275-6225
NPI assigned
Oct 5, 2026
Last updated
Oct 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

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

Authorized official

Name
Soon Burnam
Title
Secretary
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X Primary

Addresses

Primary practice location

515 Fairview Ave
Canon City, CO 81212-2863

Mailing address

515 Fairview Ave
Canon City, CO 81212-2863
Phone (719) 275-0665

Other names 1

  • Skyline Ridge Health and Rehabilitation Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1366346256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 FAIRVIEW AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122863",
            "telephone_number": "719-275-0665",
            "fax_number": "719-275-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 FAIRVIEW AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122863",
            "telephone_number": "719-275-0665",
            "fax_number": "719-275-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCHA MOOR HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Ridge Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.