Healthcare Provider Details

I. General information

NPI: 1033281514
Provider Name (Legal Business Name): KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 16TH STREET
BURLINGTON CO
80807-1651
US

IV. Provider business mailing address

286 16TH STREET
BURLINGTON CO
80807-1651
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-4721
  • Fax: 719-346-5647
Mailing address:
  • Phone: 719-346-4721
  • Fax: 719-346-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number0905
License Number StateCO

VIII. Authorized Official

Name: MS. AMBER BRAKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 719-346-4721