Provider Demographics
NPI:1982652350
Name:HOSPICE OF MONTEZUMA, INC.
Entity Type:Organization
Organization Name:HOSPICE OF MONTEZUMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-4400
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-0740
Mailing Address - Country:US
Mailing Address - Phone:970-565-4400
Mailing Address - Fax:
Practice Address - Street 1:512 N BROADWAY
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2002
Practice Address - Country:US
Practice Address - Phone:970-565-4400
Practice Address - Fax:970-565-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2003-HOSPCIE-940251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO022064Medicaid
CO126214Medicaid
CO061522Medicare ID - Type Unspecified