Provider Demographics
NPI:1528381928
Name:VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE INC
Entity Type:Organization
Organization Name:VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE INC
Other - Org Name:CREEDE FAMILY PRACTICE OF RIO GRANDE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION SEC/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-850-4948
Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8758
Mailing Address - Country:US
Mailing Address - Phone:719-657-2510
Mailing Address - Fax:719-657-2511
Practice Address - Street 1:802 RIO GRANDE
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130-0755
Practice Address - Country:US
Practice Address - Phone:719-658-0929
Practice Address - Fax:719-658-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO068503Medicare Oscar/Certification