NPIMap

Organization Active NPI

Wellsprings Care Center LLC

Doing business as Wellsprings Care Center

  • Skilled Nursing Facility
  • Englewood, CO
National Provider Identifier
1649002973
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WELLSPRINGS CARE CENTER LLC
Doing business as
Wellsprings Care Center
Practice address
3636 S Pearl St
Englewood, CO 80113-3806
Phone
(303) 761-1640
Fax
(303) 761-3133
NPI assigned
Aug 15, 2024
Last updated
Aug 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Authorized official

Name
Mary Koretke
Title
Director Cost Reporting
Phone
(720) 974-6278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3636 S Pearl St
Englewood, CO 80113-3806

Mailing address

3636 S Pearl St
Englewood, CO 80113-3806
Phone (303) 761-1640

Other names 1

  • Wellsprings Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250318003649 CO Part A Provider - Skilled Nursing Facility 5294257317 Practice locations: Englewood, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649002973. Details of each certification follow.

Skilled nursing facility certification: CCN 065208

Legal name
WELLSPRINGS CARE CENTER LLC
Doing business as
WELLSPRINGS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1985
Last certification
Feb 14, 2024
Beds
81
Ownership / control type
Corporation
Multi-facility organization
Vivage-Beecan
Organization structure
LLCProprietary
Enrollment address
3636 S Pearl St
Englewood, CO 80113-3806
Nursing home name
WELLSPRINGS CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wellsprings Care CenterCCN 065208 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8170.6 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Wellsprings Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Karla Valle Individual Corporate OfficerChief Operating Officer Sep 1, 2024 100%
Adp of the SNF Sep 1, 2024
Wellsprings SNF Holdings LLC Organization, Sacramento, CA Created for acquisition, LLC, Holding company 5% Or Greater Direct Ownership Interest Sep 1, 2024 99.99%
Mary E Koretke Individual Adp of the SNF Sep 1, 2024
Jeannae Dergance Individual Adp of the SNF Sep 1, 2024
Jay H Moskowitz Individual Corporate OfficerChief Executive Officer Sep 1, 2024 100%
Adp of the SNF Sep 1, 2024
Lourie Montoya Individual Operational/Managerial Control Oct 20, 2015
Adp of the SNF Oct 20, 2015
Chaim M Raskin Individual Corporate DirectorPresident Sep 1, 2024 100%
Adp of the SNF Sep 1, 2024
Organization, Sacramento, CA Created for acquisition, LLC, Holding company Direct Ownership Interest Sep 1, 2024 0.01%
Beecan Health Co LLC Organization, Glendale, CO LLC, Management services company Operational/Managerial Control Sep 1, 2024
Adp of the SNF Sep 1, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

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": "1723680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1649002973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 S PEARL ST",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133806",
            "telephone_number": "303-761-1640",
            "fax_number": "303-761-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 S PEARL ST",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133806",
            "telephone_number": "303-761-1640",
            "fax_number": "303-761-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRINGS CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-15",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "KORETKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR COST REPORTING",
        "authorized_official_telephone_number": "720-974-6278"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellsprings Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Englewood, CO

Sources for this page

Verify at the official NPI Registry.