Provider Demographics
NPI:1508570219
Name:WEIR HOMETOWN HEALTHCARE LLC
Entity Type:Organization
Organization Name:WEIR HOMETOWN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:970-564-7171
Mailing Address - Street 1:106 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3749
Mailing Address - Country:US
Mailing Address - Phone:970-564-7171
Mailing Address - Fax:
Practice Address - Street 1:106 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3749
Practice Address - Country:US
Practice Address - Phone:970-564-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000202304Medicaid