Provider Demographics
NPI:1326041252
Name:SANGRE DE CRISTO HOSPICE & PALLIATIVE CARE
Entity Type:Organization
Organization Name:SANGRE DE CRISTO HOSPICE & PALLIATIVE 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 1:1920 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1764
Mailing Address - Country:US
Mailing Address - Phone:719-542-0032
Mailing Address - Fax:719-542-1413
Practice Address - Street 1:1920 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1764
Practice Address - Country:US
Practice Address - Phone:719-542-0032
Practice Address - Fax:719-542-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0449251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35730OtherBCBS
CO05800164Medicaid
COC0AAA3799OtherMEDICARE B
CO35730OtherHMO OF CO
CO35730OtherHMO OF CO
CO513448Medicare ID - Type UnspecifiedPART B
CO061510Medicare ID - Type Unspecified