Provider Demographics
NPI:1710081070
Name:EASTERN RIO BLANCO COUNTY HEALTH SERVICE DISTRICT
Entity Type:Organization
Organization Name:EASTERN RIO BLANCO COUNTY HEALTH SERVICE DISTRICT
Other - Org Name:WALBRIDGE MEMORIAL CONVALESCENT WING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-878-9260
Mailing Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-3181
Mailing Address - Country:US
Mailing Address - Phone:970-878-5047
Mailing Address - Fax:970-878-3285
Practice Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-3181
Practice Address - Country:US
Practice Address - Phone:970-878-5047
Practice Address - Fax:970-878-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0474314000000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68523238Medicaid