Provider Demographics
NPI:1184683278
Name:CONEJOS COUNTY HOSPITAL CORPORATION LONG TERM CARE UNIT
Entity Type:Organization
Organization Name:CONEJOS COUNTY HOSPITAL CORPORATION LONG TERM CARE UNIT
Other - Org Name:CONEJOS COUNTY HOSPITAL DISTRICT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HIPAA PRIVACY SECURITY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:INGE
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-274-6029
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:16021 STATE HWY 285
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140
Mailing Address - Country:US
Mailing Address - Phone:719-274-6058
Mailing Address - Fax:719-274-6003
Practice Address - Street 1:19021 STATE HWY 885
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140
Practice Address - Country:US
Practice Address - Phone:719-274-6058
Practice Address - Fax:719-274-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47174838Medicaid