Provider Demographics
NPI:1083882518
Name:RED WILLOWS, INC
Entity Type:Organization
Organization Name:RED WILLOWS, INC
Other - Org Name:SAN LUIS VALLEY TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-5734
Mailing Address - Street 1:183 BROADWAY AVE
Mailing Address - Street 2:PO BOX 1316
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2801
Mailing Address - Country:US
Mailing Address - Phone:719-589-5734
Mailing Address - Fax:719-587-9047
Practice Address - Street 1:183 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2801
Practice Address - Country:US
Practice Address - Phone:719-589-5734
Practice Address - Fax:719-587-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71350381Medicaid