Provider Demographics
NPI:1326047614
Name:SUMMITWEST CARE
Entity Type:Organization
Organization Name:SUMMITWEST CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-263-0202
Mailing Address - Street 1:2800 PRINTERS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-3944
Mailing Address - Country:US
Mailing Address - Phone:970-263-0202
Mailing Address - Fax:970-243-6855
Practice Address - Street 1:2800 PRINTERS WAY STE 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-3944
Practice Address - Country:US
Practice Address - Phone:970-263-0202
Practice Address - Fax:970-243-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOLO DOESN'T LICENSE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64907856Medicaid
CO37757539Medicaid
CO38659701Medicaid
CO64907856Medicaid