Healthcare Provider Details

I. General information

NPI: 1396408100
Provider Name (Legal Business Name): VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

IV. Provider business mailing address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-2510
  • Fax: 719-651-2511
Mailing address:
  • Phone: 719-657-2510
  • Fax: 719-657-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: JENNY M GALLEGOS
Title or Position: ADMIN SEC/CRED
Credential:
Phone: 719-850-4948