Provider Demographics
NPI:1518324441
Name:VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE INC
Entity Type:Organization
Organization Name:VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE INC
Other - Org Name:MONTE VISTA MEDICAL CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-657-4104
Mailing Address - Street 1:1033 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1737
Mailing Address - Country:US
Mailing Address - Phone:719-628-0533
Mailing Address - Fax:
Practice Address - Street 1:1033 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1737
Practice Address - Country:US
Practice Address - Phone:719-628-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO16800001053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157724OtherPK