Provider Demographics
NPI:1336675339
Name:LONGS PEAK HOSPITAL
Entity Type:Organization
Organization Name:LONGS PEAK HOSPITAL
Other - Org Name:LONGS PEAK HOSPITAL PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-718-1255
Mailing Address - Street 1:1750 E KEN PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 E KEN PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGS PEAK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy