Provider Demographics
NPI:1043670185
Name:INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS INC
Entity type:Organization
Organization Name:INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORETKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-974-6278
Mailing Address - Street 1:3625 PARKMOOR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5205
Mailing Address - Country:US
Mailing Address - Phone:719-550-0200
Mailing Address - Fax:719-637-0756
Practice Address - Street 1:3625 PARKMOOR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5205
Practice Address - Country:US
Practice Address - Phone:719-550-0200
Practice Address - Fax:719-637-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO020542314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04139523Medicaid
065252Medicare Oscar/Certification