Provider Demographics
NPI:1790002483
Name:GKH HOLDINGS
Entity Type:Organization
Organization Name:GKH HOLDINGS
Other - Org Name:PARK COUNTY AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HALLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:719-838-0328
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-1295
Mailing Address - Country:US
Mailing Address - Phone:719-838-0328
Mailing Address - Fax:719-836-4874
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:102
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-1295
Practice Address - Country:US
Practice Address - Phone:719-838-0328
Practice Address - Fax:719-836-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD20231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07003015Medicaid
CO07003015Medicaid