Provider Demographics
NPI:1245801422
Name:HUERFANO LAS ANIMAS AREA COUNCIL OF GOVERNMENTS
Entity Type:Organization
Organization Name:HUERFANO LAS ANIMAS AREA COUNCIL OF GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-845-1133
Mailing Address - Street 1:300 S BONAVENTURE AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2047
Mailing Address - Country:US
Mailing Address - Phone:719-845-1133
Mailing Address - Fax:719-845-1130
Practice Address - Street 1:300 S BONAVENTURE AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2047
Practice Address - Country:US
Practice Address - Phone:719-845-1133
Practice Address - Fax:719-845-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04138194Medicaid