Northglenn Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

NORTHGLENN OPERATIONS, LLC

Doing business as

Avamere Transitional Care and Rehabilitation-Malley

Practice address

401 Malley Dr
Northglenn, CO 80233-2024

Phone

(303) 452-4700

NPI assigned

Oct 5, 2021

Organization subpart

No

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

Authorized official

Name

Ronald A Odermott

Title

Cfo

Phone

(503) 783-2489

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Avamere Transitional Care and Rehabilitation-Malley Doing business as

Tax ID family

Avamere Transitional Care and Rehabilitation-Malley2 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.

• Northglenn Operations, LLC

  dba Avamere Transitional Care and Rehabilitation-Malley

  • Respite Care
  • Northglenn, CO
  • NPI 1699434209
  NPD tax ID

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1912679168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25115 SW PARKWAY AVE STE B",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708891",
            "telephone_number": "503-783-2489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MALLEY DR",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802332024",
            "telephone_number": "303-452-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHGLENN OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "ODERMOTT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "503-783-2489"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01279700",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avamere Transitional Care and Rehabilitation-Malley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Northglenn Operations, LLC (Avamere Transitional Care and Rehabilitation-Malley)
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• Ashley Norton
• Conrad Noyola Jr.

• Skilled Nursing Facility in Northglenn, CO
• Providers in Northglenn, CO by specialty
• Skilled Nursing Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.