Provider Demographics
NPI:1174194013
Name:SANGRE DE CRISTO COMMUNITY CARE
Entity Type:Organization
Organization Name:SANGRE DE CRISTO COMMUNITY CARE
Other - Org Name:SANGRE DE CRISTO COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-0032
Mailing Address - Street 1:809 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-2149
Mailing Address - Country:US
Mailing Address - Phone:719-569-4518
Mailing Address - Fax:719-738-5752
Practice Address - Street 1:615 WALSEN AVE STE 1
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-2474
Practice Address - Country:US
Practice Address - Phone:719-569-4518
Practice Address - Fax:719-738-5752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANGRE DE CRISTO COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-01
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health