Healthcare Provider Details

I. General information

NPI: 1447219472
Provider Name (Legal Business Name): CONEJOS COUNTY HOSPITAL LTCU CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 STATE HWY
LA JARA CA
81140
US

IV. Provider business mailing address

19021 STATE HWY PO BOX 639
LA JARA CA
81140
US

V. Phone/Fax

Practice location:
  • Phone: 719-274-6058
  • Fax: 719-274-6003
Mailing address:
  • Phone: 719-274-6058
  • Fax: 719-274-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIGITTE INGE FOUST
Title or Position: HIPPA PRIVACY SECURITY OFFICER
Credential:
Phone: 719-274-6029