Healthcare Provider Details

I. General information

NPI: 1790760361
Provider Name (Legal Business Name): COUNTY OF GRAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 W AGATE AVENUE
GRANBY CO
80446-1457
US

IV. Provider business mailing address

P.O. BOX 1457
GRANBY CO
80446-1457
US

V. Phone/Fax

Practice location:
  • Phone: 970-887-2732
  • Fax: 970-887-1698
Mailing address:
  • Phone: 970-887-2732
  • Fax: 970-887-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateCO

VIII. Authorized Official

Name: MR. EDWARD T MOYER
Title or Position: COUNTY MANAGER
Credential:
Phone: 970-725-3101