Provider Demographics
NPI:1013952472
Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Entity Type:Organization
Organization Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:970-641-0704
Mailing Address - Street 1:1498 W TOMICHI AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3703
Mailing Address - Country:US
Mailing Address - Phone:970-641-0704
Mailing Address - Fax:
Practice Address - Street 1:1498 W TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3703
Practice Address - Country:US
Practice Address - Phone:970-641-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R871310400000X
CO020999314000000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10487361Medicaid
CO05652367Medicaid
CO74688278Medicaid
CO74688278Medicaid