Provider Demographics
NPI:1831292176
Name:DOLORES COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:DOLORES COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCOME MAINTENANCE
Authorized Official - Prefix:
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-677-2250
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:DOVE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81324-0485
Mailing Address - Country:US
Mailing Address - Phone:970-677-2250
Mailing Address - Fax:970-677-2859
Practice Address - Street 1:409 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:DOVE CREEK
Practice Address - State:CO
Practice Address - Zip Code:81324
Practice Address - Country:US
Practice Address - Phone:970-677-2250
Practice Address - Fax:970-677-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416A0800XTransportation ServicesAmbulanceAir Transport
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Not Answered347B00000XTransportation ServicesBus
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
06200174OtherMEDICAID PROVIDER
127249OtherTRADING PARTNER