Provider Demographics
NPI:1447558481
Name:SAGUACHE COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:SAGUACHE COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-655-2533
Mailing Address - Street 1:P.O. BOX 68
Mailing Address - Street 2:505 3RD STREET
Mailing Address - City:SAGUACHE
Mailing Address - State:CO
Mailing Address - Zip Code:81149
Mailing Address - Country:US
Mailing Address - Phone:719-655-2533
Mailing Address - Fax:719-655-0105
Practice Address - Street 1:505 3RD STREET
Practice Address - Street 2:
Practice Address - City:SAGUACHE
Practice Address - State:CO
Practice Address - Zip Code:81149
Practice Address - Country:US
Practice Address - Phone:719-655-2533
Practice Address - Fax:719-655-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO169624251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69750050Medicaid