Provider Demographics
NPI:1003089426
Name:WEST ROUTT RURAL HEALTH COUNCIL
Entity Type:Organization
Organization Name:WEST ROUTT RURAL HEALTH COUNCIL
Other - Org Name:THE HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-276-1414
Mailing Address - Street 1:300 S SHELTON LN
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:CO
Mailing Address - Zip Code:81639-9634
Mailing Address - Country:US
Mailing Address - Phone:970-276-4484
Mailing Address - Fax:970-276-4197
Practice Address - Street 1:300 S SHELTON LN
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:CO
Practice Address - Zip Code:81639-9634
Practice Address - Country:US
Practice Address - Phone:970-276-4484
Practice Address - Fax:970-276-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0515310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04182143Medicaid