NPIMap

Organization Active NPI

1111 Bonforte Opco LLC

  • Skilled Nursing Facility
  • Pueblo, CO
National Provider Identifier
1588222863
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
1111 BONFORTE OPCO LLC
Practice address
855 Hunter Dr.
Pueblo, CO 81001
Phone
(719) 545-5911
NPI assigned
Jun 3, 2019
Last updated
Jun 3, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
1111 BONFORTE OPCO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary
Respite Care 385H00000X NU

Addresses

Primary practice location

855 Hunter Dr.
Pueblo, CO 81001

Mailing address

855 Hunter Dr.
Pueblo, CO 81001

National Provider Directory

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

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559520000000",
    "number": "1588222863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 HUNTER DR.",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 HUNTER DR.",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81001",
            "telephone_number": "719-545-5911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1111 BONFORTE OPCO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1111 BONFORTE OPCO LLC",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "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
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.