PUEBLO CARE AND REHAB (NPI# 1225373418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225373418 |
| Entity Type | Organization |
| Organization Name | PUEBLO CARE AND REHAB |
| Practice Address |
2611 Jones Ave Pueblo CO 81004-2650 |
| Practice Telephone | 7195444408 |
| Practice Fax Number | 7195661960 |
| Mailing Telephone | 7195444408 |
| Mailing Fax Number | 7195661960 |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2017-06-22 |
| Authorized Official Name | KAREN WILSON WILSON (CERTIFIED OT ASSISTANT/COTA) |
| Authorized Official Telephone | 7195444408 |
| Authorized Official Credential | CERTIFICATION |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 385H00000X | Respite Care | 1401044 | CO | Respite Care Facility |
| Y | 314000000X | Skilled Nursing Facility | 1401044 | CO | Nursing & Custodial Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PUEBLO CARE AND REHABILITATION CENTER | 2611 Jones Ave, Pueblo, CO 81004-2650 |
| Street Address |
2611 JONES AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81004-2650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598719312 | Peak Medical Colorado No. 2, LLC | Respite Care | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2006-05-19 |
| 1952918112 | John Zachary Merchant | Physical Therapy Assistant | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2020-09-30 |
| 1588282487 | Amanda Lamberti | Speech-Language Pathologist | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2020-07-08 |
| 1629627021 | Emma Match | Speech-Language Pathologist | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2019-09-09 |
| 1285116004 | Stephanie Rae Dionisio | Occupational Therapy Assistant | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2018-08-29 |
| 1528567245 | Lawrence Beller | Occupational Therapy Assistant | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2018-02-08 |
| 1174036784 | Kayla Ann Fisher | Occupational Therapy Assistant | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2017-11-06 |
| 1609304831 | Morgan Cooper | Speech-Language Pathologist | 2611 Jones Ave, Pueblo, CO 81004 | 2017-06-01 |
| 1811422876 | Betty Woodside | Physical Therapy Assistant | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2017-04-27 |
| 1184014656 | Joan Gallagher | Speech-Language Pathologist | 2611 Jones Ave, Pueblo, CO 81004-2650 | 2015-02-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155929 | Renee C Lane | Nurse Practitioner | 1925 E. Orman Ave. Ste. A109, Pueblo, CO 81004 | 2018-12-16 |
| 1215406913 | Kaiser Foundation Healthplan of Colorado | Pharmacy | 2625 W. Pueblo Blvd, Pueblo, CO 81004 | 2018-11-26 |
| 1053895532 | Rebecka Ann Reatherford | Nurse Practitioner | St Mary-corwin Medical Center, 1008 Minnequa Ave, Pueblo, CO 81004 | 2018-09-20 |
| 1124510821 | Angela M Sillas-green | Counselor | 327 Colorado Ave., Pueblo, CO 81004 | 2018-05-30 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1578098752 | James Williams | Counselor | 414 Broadway Ave, Pueblo, CO 81004 | 2017-04-26 |
| 1740732601 | Valerie A Senger | Counselor | 635 W Corona Ave Ste 214, Pueblo, CO 81004 | 2016-10-26 |
| 1194111500 | A New Leaf Therapy, Pllc | Community/Behavioral Health | 327 Colorado Ave, Pueblo, CO 81004 | 2015-04-13 |
| 1619371671 | Mariah Mcginnis | Registered Nurse | 1232 Van Buren St., Pueblo, CO 81004 | 2014-10-20 |
| 1730593112 | Maritza Martinez | Registered Nurse | 1026 Wabriendo Ave, Pueblo, CO 81004 | 2014-06-13 |
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| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407211931 | Center At Park West, LLC | Skilled Nursing Facility | 3727 Parker Blvd., Pueblo, CO 81008 | 2015-12-29 |
| 1194148940 | Rose Marie Javornik | Skilled Nursing Facility | 5601 Verde Rd, Pueblo, CO 81004-9735 | 2014-01-30 |
| 1366881237 | Wsi Personel | Skilled Nursing Facility | 2610 Hollywood Dr, Pueblo, CO 81005-3313 | 2013-06-24 |
| 1588954598 | Mariah Lynn Mikulas | Skilled Nursing Facility | 2724 Franklin Ave, Pueblo, CO 81003-1330 | 2011-04-11 |
| 1891882957 | South Pueblo Medical Investors, LLC | Skilled Nursing Facility | 2118 Chatalet Ln, Pueblo, CO 81005-4625 | 2006-10-09 |
| 1265537591 | Continuum At Sharmar, Inc. | Skilled Nursing Facility | 1201 W Abriendo Ave, Pueblo, CO 81004-1003 | 2006-09-13 |
| 1861508822 | Catholic Health Initiatives Colorado | Skilled Nursing Facility | 1111 Bonforte Blvd, Pueblo, CO 81001-1801 | 2006-08-22 |
| 1922000371 | Pitman Place, LLC | Skilled Nursing Facility | 1610 Scranton Ave, Pueblo, CO 81004-2676 | 2005-08-15 |
| 1619978426 | Pitman Place, LLC | Skilled Nursing Facility | 2515 Pitman Pl, Pueblo, CO 81004-2633 | 2005-08-02 |
| 1801418256 | Center At Park West, LLC | Skilled Nursing Facility | St. Mary Corwin Medical Center, 1008 Minnequa Avenue, Pueblo, CO 81004 | 2020-05-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.