Poncha Moor Healthcare, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PONCHA MOOR HEALTHCARE, INC

Doing business as

Skyline Ridge Health and Rehabilitation

Practice address

515 Fairview Ave
Canon City, CO 81212-2863

Phone

(719) 275-0665

Fax

(719) 275-6225

NPI assigned

Aug 5, 2026

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Secretary

Phone

(949) 540-1249

Specialties & licenses 2

Addresses

Other names 1

• SKYLINE RIDGE HEALTH AND REHABILITATION Doing business as

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

{
    "created_epoch": "1785888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785888000000",
    "number": "1962326660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 FAIRVIEW AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122863",
            "telephone_number": "719-275-0665",
            "fax_number": "719-275-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 FAIRVIEW AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122863",
            "telephone_number": "719-275-0665",
            "fax_number": "719-275-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCHA MOOR HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-05",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SKYLINE RIDGE HEALTH AND REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Phyllis A Pennington, DO
• Paula M. Peterson, LMT, MSOM
• Carol J Pfaffly, PHD
• William Robert Pierce
• Alexandra Catherine Pluta, LCSW
• Phillip Earl Pontious, DMD
• Poudre Valley Medical Group, LLC
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Sarah Marie Pridemore, PTA

• Skilled Nursing Facility in Canon City, CO
• Providers in Canon City, 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 Aug 5, 2026; 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.