Healthcare Provider Details

I. General information

NPI: 1184683278
Provider Name (Legal Business Name): CONEJOS COUNTY HOSPITAL CORPORATION LONG TERM CARE UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 STATE HWY 885
LA JARA CO
81140
US

IV. Provider business mailing address

PO BOX 639 16021 STATE HWY 285
LA JARA CO
81140
US

V. Phone/Fax

Practice location:
  • Phone: 719-274-6058
  • Fax: 719-274-6003
Mailing address:
  • Phone: 719-274-6058
  • Fax: 719-274-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIGITTE INGE FOUST
Title or Position: HIPAA PRIVACY SECURITY OFFICER
Credential:
Phone: 719-274-6029