Provider Demographics
NPI:1609514983
Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Other - Org Name:ST. VINCENT BEHAVIORAL HEALTH LONGMONT
Other - Org Type:Other Name
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-260-0476
Mailing Address - Street 1:816 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3861
Mailing Address - Country:US
Mailing Address - Phone:719-486-0230
Mailing Address - Fax:719-486-1077
Practice Address - Street 1:1361 FRANCIS ST STE 103
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2545
Practice Address - Country:US
Practice Address - Phone:303-872-4077
Practice Address - Fax:719-486-1077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT GENERAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-25
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty