Healthcare Provider Details

I. General information

NPI: 1992243299
Provider Name (Legal Business Name): HUERFANO LAS ANIMAS AREA COUNCIL OF GOVERNMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N POLK AVE
WALSENBURG CO
81089-1549
US

IV. Provider business mailing address

625 N POLK AVE
WALSENBURG CO
81089-1549
US

V. Phone/Fax

Practice location:
  • Phone: 719-738-2205
  • Fax: 719-738-6898
Mailing address:
  • Phone: 719-738-2205
  • Fax: 719-738-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number10F196
License Number StateCO

VIII. Authorized Official

Name: MR. WALTER BOULDEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-845-1133