Active NPI
Holly Nursing Care Center, Inc
- Skilled Nursing Facility
- Holly, CO
National Provider Identifier
1669845129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 020237
- Legal business name
- HOLLY NURSING CARE CENTER, INC
- Practice address
- 320 N 8TH St
Holly, CO 81047 - Phone
- (719) 537-6555
- Fax
- (719) 537-6366
- NPI assigned
- Nov 5, 2015
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 020237 | CO | Primary |
Addresses
Primary practice location
320 N 8TH St
Holly, CO 81047
Mailing address
PO Box 636
Holly, CO 81047-0636
Phone (719) 537-6555
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05655147 | Medicaid | CO | |
| 4138426 | Medicaid | CO |
Other names 1
- Holly Nursing Care Center
National Provider Directory
National Provider Directory- Tax ID family
- Holly Nursing Care Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Inpatient Hospice
- Holly, CO
- NPI 1285632372
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapy Assistant
- Holly, CO
- NPI 1801085386
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446681600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1446681600000",
"number": "1669845129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 636",
"city": "HOLLY",
"state": "CO",
"postal_code": "810470636",
"telephone_number": "719-537-6555",
"fax_number": "719-537-6366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 N 8TH ST",
"city": "HOLLY",
"state": "CO",
"postal_code": "81047",
"telephone_number": "719-537-6555",
"fax_number": "719-537-6366"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLLY NURSING CARE CENTER, INC",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-05",
"last_updated": "2015-11-05",
"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": "020237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05655147",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4138426",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Holly Nursing Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Holly, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.