Provider Demographics
NPI:1609022946
Name:KIT CARSON COUNTY HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:KIT CARSON COUNTY HEALTH AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MULCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-346-7158
Mailing Address - Street 1:252 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-2321
Mailing Address - Country:US
Mailing Address - Phone:719-346-7158
Mailing Address - Fax:719-346-8066
Practice Address - Street 1:252 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-2321
Practice Address - Country:US
Practice Address - Phone:719-346-7158
Practice Address - Fax:719-346-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69240163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04470092Medicaid