Provider Demographics
NPI:1013911437
Name:NORTHEAST COLORADO HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:NORTHEAST COLORADO HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:970-522-3741
Mailing Address - Street 1:700 COLUMBINE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751
Mailing Address - Country:US
Mailing Address - Phone:970-522-3741
Mailing Address - Fax:970-522-1412
Practice Address - Street 1:700 COLUMBINE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3728
Practice Address - Country:US
Practice Address - Phone:970-522-3741
Practice Address - Fax:970-522-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98-05302251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07569957Medicaid
CO10153273Medicaid
CO11781238Medicaid
CO30987521Medicaid
CO41773225Medicaid
CO03378781Medicaid
CO04427092Medicaid
CO46835725Medicaid
CO96175222Medicaid
CO01215243Medicaid
CO07549405Medicaid
CO07537871Medicaid
CO69456020Medicaid