Provider Demographics
NPI:1821092495
Name:HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Entity Type:Organization
Organization Name:HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Other - Org Name:HEALTH DISTRICT OF NORTHERN LARIMER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-224-5209
Mailing Address - Street 1:120 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2031
Mailing Address - Country:US
Mailing Address - Phone:970-224-5209
Mailing Address - Fax:970-472-0440
Practice Address - Street 1:425 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2864
Practice Address - Country:US
Practice Address - Phone:970-224-5209
Practice Address - Fax:970-472-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63884275Medicaid
CO63884275Medicaid