Provider Demographics
NPI:1619060639
Name:SOUTHEAST COLORADO HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTHEAST COLORADO HOSPITAL DISTRICT
Other - Org Name:HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-523-2125
Mailing Address - Street 1:373 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1622
Mailing Address - Country:US
Mailing Address - Phone:719-523-4057
Mailing Address - Fax:719-523-4575
Practice Address - Street 1:204 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1621
Practice Address - Country:US
Practice Address - Phone:719-523-4057
Practice Address - Fax:719-523-4575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST COLORADO HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05700604Medicaid
CO067198Medicare Oscar/Certification