NPIMap

Organization Active NPI

Shalom Park

  • Skilled Nursing Facility
  • Aurora, CO
National Provider Identifier
1861430068
Registry record updated Apr 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0906 Issued in CO
Legal business name
SHALOM PARK
Practice address
14800 E Belleview Dr
Aurora, CO 80015-2258
Phone
(303) 680-5000
Fax
(303) 699-4300
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2019

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

Authorized official

Name
Mr. Marc Penner
Title
President/Ceo
Phone
(303) 680-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0906 CO Primary

Addresses

Primary practice location

14800 E Belleview Dr
Aurora, CO 80015-2258

Mailing address

14800 E Belleview Drive
Aurora, CO 80015-2258
Phone (303) 680-5000

Other identifiers 1

IdentifierTypeStateIssuer
05651815MedicaidCO

Other names 1

  • BETH ISRAEL AT SHALOM PARK Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091216000187 CO Part A Provider - Skilled Nursing Facility 4688771967 Practice locations: Aurora, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861430068. Details of each certification follow.

Skilled nursing facility certification: CCN 065303

Legal name
SHALOM PARK
Doing business as
BETH ISRAEL AT SHALOM PARK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Sep 8, 1992
Last certification
Oct 26, 2023
Beds
135
Ownership / control type
Church Related
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1984 in CO
Enrollment address
14800 E Belleview Drive
Aurora, CO 80015-2258
Nursing home name
BETH ISRAEL AT SHALOM PARK

Care Compare: Nursing home

Medicare Care Compare
Listed as
Beth Israel at Shalom ParkCCN 065303 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Sep 8, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
135140.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Romano Nteela Abuaba Individual Adp of the SNF Aug 1, 2022
Marc S Penner Individual Corporate DirectorPresident/Ceo Oct 1, 2017
Operational/Managerial Control Oct 1, 2017
Mindy Moskowitz Individual Corporate OfficerAdministrator/Coo Jan 1, 2025
Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 23, 2026

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1861430068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 E BELLEVIEW DRIVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800152258",
            "telephone_number": "303-680-5000",
            "fax_number": "303-699-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 E BELLEVIEW DR",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800152258",
            "telephone_number": "303-680-5000",
            "fax_number": "303-699-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "PENNER",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "303-680-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "0906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05651815",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BETH ISRAEL AT SHALOM PARK",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "BETH ISRAEL AT SHALOM PARK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.