Healthcare Provider Details

I. General information

NPI: 1073749487
Provider Name (Legal Business Name): SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PROSPECT AVE
SPRINGER NM
87747
US

IV. Provider business mailing address

615 PROSPECT AVENUE
SPRINGER NM
87747
US

V. Phone/Fax

Practice location:
  • Phone: 575-483-3300
  • Fax: 575-483-3344
Mailing address:
  • Phone: 575-483-3300
  • Fax: 575-483-3344

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: ASHLEY DEHERRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-483-3301