Provider Demographics
NPI:1609834449
Name:COUNTY OF CHAFFEE
Entity Type:Organization
Organization Name:COUNTY OF CHAFFEE
Other - Org Name:CHAFFEE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:719-539-4510
Mailing Address - Street 1:448 E 1ST ST
Mailing Address - Street 2:SUITE 137
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2804
Mailing Address - Country:US
Mailing Address - Phone:719-539-4510
Mailing Address - Fax:719-539-7197
Practice Address - Street 1:448 E 1ST ST
Practice Address - Street 2:SUITE 137
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2804
Practice Address - Country:US
Practice Address - Phone:719-539-4510
Practice Address - Fax:719-539-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
600001932OtherRAILROAD MEDICARE
CO04419099Medicaid
600001932OtherRAILROAD MEDICARE