Provider Demographics
NPI:1295510600
Name:PROWERS COUNTY PUBLIC HEALTH OLTC
Entity type:Organization
Organization Name:PROWERS COUNTY PUBLIC HEALTH OLTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JO LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-8721
Mailing Address - Street 1:1001 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-1015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROWERS COUNTY NURSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management