Healthcare Provider Details

I. General information

NPI: 1700489853
Provider Name (Legal Business Name): NORTHWEST COLORADO VISITING NURSE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 YAMPA AVE
CRAIG CO
81625-2609
US

IV. Provider business mailing address

745 RUSSELL ST
CRAIG CO
81625-2019
US

V. Phone/Fax

Practice location:
  • Phone: 970-871-7629
  • Fax:
Mailing address:
  • Phone: 970-824-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LESLEE HURST
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 970-871-7680