Provider Demographics
NPI:1841870623
Name:TRINIDAD AREA HEALTH ASSOCIATION
Entity type:Organization
Organization Name:TRINIDAD AREA HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:TOPPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-845-3168
Mailing Address - Street 1:410 BENEDICTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2005
Mailing Address - Country:US
Mailing Address - Phone:719-845-3168
Mailing Address - Fax:719-846-3370
Practice Address - Street 1:410 BENEDICTA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2005
Practice Address - Country:US
Practice Address - Phone:719-845-3168
Practice Address - Fax:719-846-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1184616740Medicaid