Healthcare Provider Details

I. General information

NPI: 1568861490
Provider Name (Legal Business Name): LAMAR ESTATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 10TH ST
LAMAR CO
81052-2622
US

IV. Provider business mailing address

205 S 10TH ST
LAMAR CO
81052-2622
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-3434
  • Fax: 719-336-2708
Mailing address:
  • Phone: 719-336-3434
  • Fax: 719-336-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. KENT M EMRY
Title or Position: MANAGING MEMBER
Credential:
Phone: 503-689-1808