Provider Demographics
NPI:1053633529
Name:KINGFISHER FOUNDATION, INC.
Entity Type:Organization
Organization Name:KINGFISHER FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROD
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-495-2166
Mailing Address - Street 1:P.O .BOX 177
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542
Mailing Address - Country:US
Mailing Address - Phone:303-495-2166
Mailing Address - Fax:303-328-2304
Practice Address - Street 1:209 MAIN STREET
Practice Address - Street 2:UNIT B
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80542
Practice Address - Country:US
Practice Address - Phone:303-495-2166
Practice Address - Fax:303-328-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-10086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty