Provider Demographics
NPI:1376259697
Name:SANGRE DE CRISTO COMMUNITY CARE CANON CITY
Entity Type:Organization
Organization Name:SANGRE DE CRISTO COMMUNITY CARE CANON CITY
Other - Org Name:
Other - Org Type:
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:719-542-1486
Practice Address - Street 1:601 GREENWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3337
Practice Address - Country:US
Practice Address - Phone:719-275-1261
Practice Address - Fax:719-275-3754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANGRE DE CRISTO COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health