Ponderosa Care Communities C, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

020423 Issued in CO

Legal business name

PONDEROSA CARE COMMUNITIES C, LLC

Doing business as

Sierra Rehabilitation and Care Community

Practice address

1432 Depew St
Lakewood, CO 80214-2237

Phone

(303) 238-1375

Fax

(303) 238-0852

NPI assigned

Feb 11, 2016

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

• Sierra Rehabilitation and Care Community Doing business as

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462147200000",
    "number": "1366801888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1432 DEPEW ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802142237",
            "telephone_number": "303-238-1375",
            "fax_number": "303-238-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 DEPEW ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802142237",
            "telephone_number": "303-238-1375",
            "fax_number": "303-238-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA CARE COMMUNITIES C, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-05-02",
        "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": "020423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23703865",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Rehabilitation and Care Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jordan Pollock, RN
• Maria Pollock
• Svetlana Polyakova, NP
• Marcia Polynice, L.P.N.
• Manuela Ponce-Naves
• Ponderosa Care Communities C, LLC
• Willaim Joseph Pontarelli Jr., D.D.S.
• Maria Suzette Pontiero, PMHNP-BC
• Evelyn Pope
• Tammy Lynn Pope, MS, ICGCII

• Skilled Nursing Facility in Lakewood, CO
• Providers in Lakewood, 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 May 2, 2016; 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.