Provider Demographics
NPI:1003688185
Name:OTERO COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:OTERO COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-383-3167
Mailing Address - Street 1:13 W 3RD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1536
Mailing Address - Country:US
Mailing Address - Phone:719-383-3167
Mailing Address - Fax:
Practice Address - Street 1:13 W 3RD ST STE 110
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1536
Practice Address - Country:US
Practice Address - Phone:719-383-3167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management