Provider Demographics
NPI:1073749487
Name:SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:COLFAX GENERAL LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-483-3301
Mailing Address - Street 1:615 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGER
Mailing Address - State:NM
Mailing Address - Zip Code:87747
Mailing Address - Country:US
Mailing Address - Phone:575-483-3300
Mailing Address - Fax:575-483-3344
Practice Address - Street 1:615 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGER
Practice Address - State:NM
Practice Address - Zip Code:87747
Practice Address - Country:US
Practice Address - Phone:575-483-3300
Practice Address - Fax:575-483-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility