Active NPI
Forest Ridge Senior Living, LLC
- Skilled Nursing Facility
- Woodland Park, CO
National Provider Identifier
1922479633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 02D453
- Legal business name
- FOREST RIDGE SENIOR LIVING, LLC
- Practice address
- 16006 W JS Highway 24
Woodland Park, CO 80863 - Phone
- (719) 686-6500
- NPI assigned
- Oct 8, 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
- Mrs. Kelley Whitaker
- Title
- Chief Operations Officer
- Phone
- (505) 369-0079
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 02D453 | CO | Primary |
Addresses
Primary practice location
16006 W JS Highway 24
Woodland Park, CO 80863
Mailing address
8820 Horizon Blvd NE
Albuquerque, NM 87113-1689
Phone (505) 369-0079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02D453 | Other | CO | DEPT. OF PUBLIC HEALTH AND ENVIRONMENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160620000309 | CO | Part A Provider - Skilled Nursing Facility | 8628369832 | Practice locations: Woodland Park, CO |
Skilled nursing facility certification: CCN 065418
- Legal name
- FOREST RIDGE SENIOR LIVING LLC
- Doing business as
- FOREST RIDGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 22, 2016
- Last certification
- May 23, 2024
- Beds
- 80
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- May 31, 2011 in CO
- Enrollment address
- 16006 W US Highway 24
Woodland Park, CO 80863-8760 - Nursing home name
- FOREST RIDGE HEALTH AND REHAB LLC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Forest Ridge Health and Rehab LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 22, 2016
- Medicare certification status
- Active
- Certified beds
- 80
National Provider Directory
National Provider DirectoryLocations
16006 W US Highway 24
Woodland Park, CO 80863
Phone (719) 354-0529
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Horace Winchester | 5% Or Greater Direct Ownership Interest | Jul 24, 2014 | 20% |
| Robert Schleicher | 5% Or Greater Indirect Ownership Interest | Jul 20, 2014 | 49.53% |
| Corporate Officer | Jul 20, 2014 | 49.53% | |
| Operational/Managerial Control | Apr 1, 2017 | 49.53% | |
| Jerry W Williamson | 5% Or Greater Direct Ownership Interest | Jul 24, 2014 | 20% |
| Onpointe Management, LLC | Operational/Managerial Control | Feb 1, 2016 | 100% |
| Forest Ridge Property LLC | 5% Or Greater Direct Ownership Interest | May 31, 2011 | 100% |
| Mid-States Senior Living LLC | 5% Or Greater Direct Ownership Interest | Jul 20, 2014 | 49.53% |
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": "1444262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1465776000000",
"number": "1922479633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8820 HORIZON BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871131689",
"telephone_number": "505-369-0079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16006 W JS HIGHWAY 24",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "80863",
"telephone_number": "719-686-6500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOREST RIDGE SENIOR LIVING, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-10-08",
"last_updated": "2016-06-13",
"status": "A",
"authorized_official_last_name": "WHITAKER",
"authorized_official_first_name": "KELLEY",
"authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
"authorized_official_telephone_number": "505-369-0079",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CO",
"license": "02D453",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF PUBLIC HEALTH AND ENVIRONMENT",
"identifier": "02D453",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodland Park, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.