Healthcare Provider Details

I. General information

NPI: 1023421641
Provider Name (Legal Business Name): RIO BLANCO BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W MAIN ST STE 219
RANGELY CO
81648-2412
US

IV. Provider business mailing address

402 W MAIN ST STE 219
RANGELY CO
81648-2412
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-2064
  • Fax: 970-675-5023
Mailing address:
  • Phone: 970-675-2064
  • Fax: 970-675-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: KRIS DENNY
Title or Position: MEDICAID COORDINATOR
Credential:
Phone: 970-675-2064