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General NPI Number Information
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NPI Number | 1164456828
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Entity Type | Organization
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Legal Business Name | BACA GRANDE PROPERTY OWNERS ASSOCIATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 68575 COUNTY RD T
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City | CRESTONE
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State | CO
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Zip | 81131-0237
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Country | US
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Telephone | 719-256-4171
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Fax | 719-256-4173
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Provider Business Mailing Address
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Address Line | PO BOX 237 68575 COUNTY ROAD T
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City | CRESTONE
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State | CO
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Zip | 81131-0237
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Country | US
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Telephone | 719-256-4171
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Fax | 719-256-4173
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. PAM L GRIPP
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Credential | PARAMEDIC
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Telephone | 719-256-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | CO
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