Provider Demographics
NPI:1073035242
Name:TRI COUNTY HOUSING & CDC
Entity Type:Organization
Organization Name:TRI COUNTY HOUSING & CDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-263-5168
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CO
Mailing Address - Zip Code:81039-0087
Mailing Address - Country:US
Mailing Address - Phone:719-263-5168
Mailing Address - Fax:719-263-5460
Practice Address - Street 1:34385 HWY 167
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CO
Practice Address - Zip Code:81039-0087
Practice Address - Country:US
Practice Address - Phone:719-263-5168
Practice Address - Fax:719-263-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty