Healthcare Provider Details

I. General information

NPI: 1336358563
Provider Name (Legal Business Name): HOUSING AUTHORITY OF THE COUNTY OF GRAND, COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EAGLE AVE
KREMMLING CO
80459
US

IV. Provider business mailing address

PO BOX 399
KREMMLING CO
80459-0399
US

V. Phone/Fax

Practice location:
  • Phone: 970-724-3530
  • Fax: 970-724-3813
Mailing address:
  • Phone: 970-887-5800
  • Fax: 970-724-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAL-0079
License Number StateCO

VIII. Authorized Official

Name: KELLY S CLASEN
Title or Position: SR. DIRECTOR, BUSINESS OPERATIONS
Credential:
Phone: 307-699-2413