Provider Demographics
NPI:1629515028
Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Entity type:Organization
Organization Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER & VP CLINICA
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-284-1004
Mailing Address - Street 1:8300 W 38TH AVE STE T2-105
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6012
Mailing Address - Country:US
Mailing Address - Phone:303-403-6420
Mailing Address - Fax:303-403-6909
Practice Address - Street 1:12911 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:303-403-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1629515028Medicaid
2168336OtherPK