Healthcare Provider Details

I. General information

NPI: 1962736561
Provider Name (Legal Business Name): RIO GRANDE INN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CALLE MILLER
LA JARA CO
81140-9756
US

IV. Provider business mailing address

1004 E MAIN ST
CORTEZ CO
81321-3326
US

V. Phone/Fax

Practice location:
  • Phone: 719-274-3311
  • Fax: 719-274-3317
Mailing address:
  • Phone: 970-516-1404
  • Fax: 970-516-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUCIANA SINGER
Title or Position: MANAGEMENT
Credential:
Phone: 970-516-1404