Provider Demographics
NPI: | 1720659667 |
---|---|
Name: | SANGRE DE CRISTO COMMUNITY CARE |
Entity Type: | Organization |
Organization Name: | SANGRE DE CRISTO COMMUNITY CARE |
Other - Org Name: | SANGRE DE CRISTO COMMUNITY CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR OF COMPLIANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JANELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SOLOMON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 719-542-0032 |
Mailing Address - Street 1: | 1502 E MAIN ST STE 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | TRINIDAD |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81082-2014 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-569-4502 |
Mailing Address - Fax: | 719-422-8358 |
Practice Address - Street 1: | 1502 E MAIN ST STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | TRINIDAD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81082-2014 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-569-4502 |
Practice Address - Fax: | 719-422-8358 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SANGRE DE CRISTO COMMUNITY CARE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-07-01 |
Last Update Date: | 2022-07-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |