Provider Demographics
NPI:1457472086
Name:BACA COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:BACA COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:BACA COUNTY CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL SERVICES SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-523-4131
Mailing Address - Street 1:772 COLORADO ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1456
Mailing Address - Country:US
Mailing Address - Phone:719-523-4131
Mailing Address - Fax:719-523-4820
Practice Address - Street 1:772 COLORADO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1456
Practice Address - Country:US
Practice Address - Phone:719-523-4131
Practice Address - Fax:719-523-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04138657171M00000X
CO06200059347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Not Answered347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04138657Medicaid
CO06200059Medicaid