1326290750 NPI number — CONEJOS COUNTY PUBLIC HEALTH AND NURSING SERVICES

Table of content: (NPI 1326290750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326290750 NPI number — CONEJOS COUNTY PUBLIC HEALTH AND NURSING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONEJOS COUNTY PUBLIC HEALTH AND NURSING SERVICES
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:
6
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:
1326290750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
6683 COUNTY RD 13
Provider Business Mailing Address City Name:
CONEJOS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-274-4307
Provider Business Mailing Address Fax Number:
719-274-4309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19023 HWY 285 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JARA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-274-4307
Provider Business Practice Location Address Fax Number:
719-274-4309
Provider Enumeration Date:
10/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JIRON
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
719-274-4307

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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