1073129912 NPI number — HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY

Table of content: (NPI 1073129912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073129912 NPI number — HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073129912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 BRISTLECONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-224-5209
Provider Business Mailing Address Fax Number:
970-472-1056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 BRISTLECONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-224-5209
Provider Business Practice Location Address Fax Number:
970-472-1056
Provider Enumeration Date:
09/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HAYWOOD
Authorized Official First Name:
A
Authorized Official Middle Name:
LORRAINE
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
970-224-5209

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04020384 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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