NPIMap

Organization Active NPI

Eagle Ridge Operating Company, LLC

  • Skilled Nursing Facility
  • Grand Junction, CO
National Provider Identifier
1942391875
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
021116 Issued in CO
Legal business name
EAGLE RIDGE OPERATING COMPANY, LLC
Practice address
2425 Teller Ave
Grand Junction, CO 81501-5141
Phone
(970) 243-3381
Fax
(970) 243-3416
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 021116 CO Primary

Addresses

Primary practice location

2425 Teller Ave
Grand Junction, CO 81501-5141

Mailing address

12136 W. Bayaud Avenue
Suite 200
Lakewood, CO 80228
Phone (720) 974-6278

Other identifiers 2

IdentifierTypeStateIssuer
417-081058MedicaidCO
1300-86863MedicaidCO

Other names 1

  • EAGLE RIDGE AT GRAND VALLEY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1942391875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12136 W. BAYAUD AVENUE",
            "address_2": "SUITE 200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "80228",
            "telephone_number": "720-974-6278",
            "fax_number": "303-987-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 TELLER AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815015141",
            "telephone_number": "970-243-3381",
            "fax_number": "970-243-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIDGE OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "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": "021116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "417-081058",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1300-86863",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAGLE RIDGE AT GRAND VALLEY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EAGLE RIDGE AT GRAND VALLEY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.