Provider Demographics
NPI:1558485748
Name:PARK COUNTY DEPT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:PARK COUNTY DEPT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYDARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-816-5930
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0968
Mailing Address - Country:US
Mailing Address - Phone:719-836-4140
Mailing Address - Fax:719-836-0508
Practice Address - Street 1:824 CASPELLO AVE
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-4140
Practice Address - Fax:719-836-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 344600000X
CO347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06200471Medicaid
23597OtherTRADING PRACTICE