Provider Demographics
NPI:1457392151
Name:LAMAR AREA HOSPICE ASSOCIATION
Entity Type:Organization
Organization Name:LAMAR AREA HOSPICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-336-2100
Mailing Address - Street 1:108 W OLIVE ST
Mailing Address - Street 2:PO BOX 843
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2704
Mailing Address - Country:US
Mailing Address - Phone:719-336-2100
Mailing Address - Fax:719-336-3845
Practice Address - Street 1:108 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2704
Practice Address - Country:US
Practice Address - Phone:719-336-2100
Practice Address - Fax:719-336-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800115Medicaid
CO061505Medicare ID - Type Unspecified