Provider Demographics
NPI:1598336422
Name:SANGRE DE CRISTO COMMUNITY CARE HOSPICE TRINIDAD
Entity Type:Organization
Organization Name:SANGRE DE CRISTO COMMUNITY CARE HOSPICE TRINIDAD
Other - Org Name:SANGRE DE CRISTO COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-0032
Mailing Address - Street 1:1502 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2014
Mailing Address - Country:US
Mailing Address - Phone:719-846-3060
Mailing Address - Fax:719-422-8358
Practice Address - Street 1:1502 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2014
Practice Address - Country:US
Practice Address - Phone:719-846-3060
Practice Address - Fax:719-422-8358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANGRE DE CRISTO HOSPICE & PALLIATIVE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69815500Medicaid