Provider Demographics
NPI:1790320901
Name:COUNTY OF LARIMER
Entity Type:Organization
Organization Name:COUNTY OF LARIMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:NEVIN-WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-498-6719
Mailing Address - Street 1:1525 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2004
Mailing Address - Country:US
Mailing Address - Phone:970-498-6719
Mailing Address - Fax:
Practice Address - Street 1:200 PERIDOT ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5198
Practice Address - Country:US
Practice Address - Phone:970-619-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LARIMER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare