Healthcare Provider Details

I. General information

NPI: 1174973796
Provider Name (Legal Business Name): COUNTY OF GRAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MOFFAT AVENUE
HOT SULPHUR SPRINGS CO
80451
US

IV. Provider business mailing address

PO BOX 264
HOT SULPHUR SPRINGS CO
80451-0264
US

V. Phone/Fax

Practice location:
  • Phone: 970-725-3288
  • Fax: 970-725-3438
Mailing address:
  • Phone: 970-725-3288
  • Fax: 970-725-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number101201
License Number StateCO

VIII. Authorized Official

Name: ELIZABETH BRENE BELEW-LADUE
Title or Position: DIRECTOR
Credential: RN
Phone: 970-725-3288