Grand Junction Wellage Pacifica, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GRAND JUNCTION WELLAGE PACIFICA, LLC

Doing business as

The Lodge at Grand Junction

Practice address

2656 Patterson Rd
Grand Junction, CO 81506-8820

Phone

(970) 822-4141

Fax

(970) 245-0771

NPI assigned

Jan 11, 2021

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 names 1

• The Lodge at Grand Junction Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1619566072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2656 PATTERSON RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815068820",
            "telephone_number": "970-822-4141",
            "fax_number": "970-245-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2656 PATTERSON RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815068820",
            "telephone_number": "970-822-4141",
            "fax_number": "970-245-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND JUNCTION WELLAGE PACIFICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lodge at Grand Junction",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Grand Junction, CO by specialty
• Assisted Living Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.