Provider Demographics
NPI:1619151941
Name:LINCOLN COUNTY WELLNESS FOUNDATION
Entity Type:Organization
Organization Name:LINCOLN COUNTY WELLNESS FOUNDATION
Other - Org Name:LINCOLN COUNTY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-768-3210
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:CO
Mailing Address - Zip Code:80821-0571
Mailing Address - Country:US
Mailing Address - Phone:719-768-3210
Mailing Address - Fax:
Practice Address - Street 1:103 THIRD ST.
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:CO
Practice Address - Zip Code:80821
Practice Address - Country:US
Practice Address - Phone:719-768-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health