Healthcare Provider Details

I. General information

NPI: 1396832820
Provider Name (Legal Business Name): VALLEY CITIZENS' FOUNDATION FOR HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310C 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: 719-657-2418
  • Fax: 719-657-3317
Mailing address:
  • Phone: 719-657-2510
  • Fax: 719-657-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number06-8504
License Number StateCO

VIII. Authorized Official

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