Healthcare Provider Details

I. General information

NPI: 1396912200
Provider Name (Legal Business Name): ARKANSAS VALLEY REGIONAL MEDICAL CENTER RESPITE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CARSON AVE
LA JUNTA CO
81050-2751
US

IV. Provider business mailing address

1100 CARSON AVE
LA JUNTA CO
81050-2751
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-6026
  • Fax:
Mailing address:
  • Phone: 719-383-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number020210
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier72980320
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: HEIDI J GEARHART
Title or Position: CNO
Credential: MSN, RN
Phone: 719-384-5412