Provider Demographics
NPI:1437519840
Name:RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN COLORADO
Entity Type:Organization
Organization Name:RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-755-4067
Mailing Address - Street 1:4223 ROYAL PINE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2824
Mailing Address - Country:US
Mailing Address - Phone:719-471-1814
Mailing Address - Fax:
Practice Address - Street 1:4223 ROYAL PINE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2824
Practice Address - Country:US
Practice Address - Phone:719-471-1814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45831351Medicaid