Healthcare Provider Details

I. General information

NPI: 1114050903
Provider Name (Legal Business Name): SALUD FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 BLUE SPRUCE DR
FORT COLLINS CO
80524-5427
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-2583
  • Fax: 970-494-4050
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number0323
License Number StateCO

VIII. Authorized Official

Name: JOHN SANTISTEVAN
Title or Position: DIRECTOR OF FINANCE AND ACCOUNTING
Credential:
Phone: 303-892-6401