Provider Demographics
NPI:1356886923
Name:COTTONWOOD INN INC
Entity type:Organization
Organization Name:COTTONWOOD INN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-516-1404
Mailing Address - Street 1:1004 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3326
Mailing Address - Country:US
Mailing Address - Phone:970-516-1404
Mailing Address - Fax:
Practice Address - Street 1:450 PROSPECTOR AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7940
Practice Address - Country:US
Practice Address - Phone:970-828-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066655Medicare UPIN