NPIMap

Organization Active NPI

Poudre Canyon Rehabilitation and Nursing, LLC

  • Skilled Nursing Facility
  • Fort Collins, CO
National Provider Identifier
1720823503
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
POUDRE CANYON REHABILITATION AND NURSING, LLC
Practice address
1000 S Lemay Ave
Fort Collins, CO 80524-3914
Phone
(970) 482-7925
NPI assigned
Jun 25, 2024
Last updated
Jun 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Authorized official

Name
Wendy Anderson
Title
Corporate Business Office Manager
Phone
(385) 498-0194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1000 S Lemay Ave
Fort Collins, CO 80524-3914

Mailing address

947 S 500 E Ste 105
American Fork, UT 84003-3392
Phone (385) 498-0194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250523000926 CO Part A Provider - Skilled Nursing Facility 6002335924 Practice locations: Fort Collins, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720823503. Details of each certification follow.

Skilled nursing facility certification: CCN 065166

Legal name
POUDRE CANYON REHABILITATION AND NURSING LLC
Doing business as
POUDRE CANYON REHABILITATION AND NURSING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1982
Last certification
Jan 22, 2025
Beds
83
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Jun 1, 2005
Organization structure
LLCProprietary
Enrollment address
1000 S Lemay Ave
Fort Collins, CO 80524-3914
Nursing home name
POUDRE CANYON REHABILITATION AND NURSING, LLC
Affiliated entity
THE CHARLY BELLO FAMILY, THE MAZE FAMILY, THE SWAIN FAMILY, & WALTER MYERS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Poudre Canyon Rehabilitation and Nursing, LLCCCN 065166 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8369.7 residents per day on average
Chain
The Charly Bello Family, the Maze Family, the Swain Family, & Walter Myers19 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $48,308

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0688401Poudre Canyon Rehabilitation and Nursing LLC1000 S Lemay Ave, Fort Collins, CO 80524Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Holly Swain Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 19.2%
Indirect Ownership Interest Sep 1, 2024 19.2%
Malcolm R Fraser Individual Adp of the SNF Oct 10, 2025
Jared E Swain Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 20.2%
Indirect Ownership Interest Sep 1, 2024 20.2%
David Mahrt Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 0.1%
Indirect Ownership Interest Sep 1, 2024 0.1%
Charly Bello Family Limited Partnership Organization, American Fork, UT Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2024 40%
Direct Ownership Interest Sep 1, 2024 40%
Organization, New York, NY LLC Adp of the SNF Sep 1, 2024
Organization, Alexandria, VA LLC Adp of the SNF Sep 1, 2024
Pickd LLC Organization, Farmington, UT LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2024 10%
Direct Ownership Interest Sep 1, 2024 10%
Organization, Woods Cross, UT LLC Adp of the SNF Sep 1, 2024
Maze Family Limited Partnership Organization, Provo, UT Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2024 50%
Direct Ownership Interest Sep 1, 2024 50%
Walter E Myers Individual 5% Or Greater Indirect Ownership InterestChief Operating Officer Sep 1, 2024 24.5%
Operational/Managerial Control Sep 1, 2024
Indirect Ownership Interest Sep 1, 2024 24.5%
Cottonwood Healthcare LLC Organization, American Fork, UT LLC Operational/Managerial Control Sep 1, 2024
Carly Bader Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF Oct 10, 2025
Organization, Saint Charles, MO LLC Adp of the SNF Sep 1, 2024
Katie Myers Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 23.5%
Indirect Ownership Interest Sep 1, 2024 23.5%

Facilities with the same owner 23

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

View all 23

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": "1719273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1720823503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 S 500 E STE 105",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840033392",
            "telephone_number": "385-498-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S LEMAY AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243914",
            "telephone_number": "970-482-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE CANYON REHABILITATION AND NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CORPORATE BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "385-498-0194"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.