Provider Demographics
NPI:1073129912
Name:HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Entity Type:Organization
Organization Name:HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-224-5209
Mailing Address - Street 1:120 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2031
Mailing Address - Country:US
Mailing Address - Phone:970-224-5209
Mailing Address - Fax:970-472-1056
Practice Address - Street 1:202 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2031
Practice Address - Country:US
Practice Address - Phone:970-224-5209
Practice Address - Fax:970-472-1056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020384Medicaid