Provider Demographics
NPI:1952686164
Name:CHINOOK HEALTHCARE IN
Entity Type:Organization
Organization Name:CHINOOK HEALTHCARE IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-458-4887
Mailing Address - Street 1:325 W S BOULDER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1130
Mailing Address - Country:US
Mailing Address - Phone:720-458-4887
Mailing Address - Fax:720-890-6144
Practice Address - Street 1:325 W S BOULDER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1130
Practice Address - Country:US
Practice Address - Phone:720-458-4887
Practice Address - Fax:720-890-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No332900000XSuppliersNon-Pharmacy Dispensing Site