Healthcare Provider Details

I. General information

NPI: 1972608321
Provider Name (Legal Business Name): KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 16TH STREET
BURLINGTON CO
80807
US

IV. Provider business mailing address

286 16TH STREET B
BURLINGTON CO
80807
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-5311
  • Fax: 719-346-5647
Mailing address:
  • Phone: 719-346-5311
  • Fax: 719-346-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1051
License Number StateCO

VIII. Authorized Official

Name: MR. BRYAN BOGLE
Title or Position: CEO
Credential:
Phone: 719-346-5311