Provider Demographics
NPI:1447588769
Name:SOUTHERN TELLER COUNTY HEALTH SERVICES DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN TELLER COUNTY HEALTH SERVICES DISTRICT
Other - Org Name:CRIPPLE CREEK HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-689-2931
Mailing Address - Street 1:700 NORTH A STREET
Mailing Address - Street 2:P O BOX 397
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813-0397
Mailing Address - Country:US
Mailing Address - Phone:719-689-2931
Mailing Address - Fax:719-689-3702
Practice Address - Street 1:700 NORTH A STREET
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813
Practice Address - Country:US
Practice Address - Phone:719-689-2931
Practice Address - Fax:719-689-3702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRIPPLE CREEK CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health