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General NPI Number Information
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NPI Number | 1821057860
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Entity Type | Organization
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Legal Business Name | LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 115 MAIN STREET
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City | ANTONITO
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State | CO
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Zip | 81120-0087
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Country | US
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Telephone | 719-376-2308
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Fax | 719-376-2395
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Provider Business Mailing Address
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Address Line | 19021 US HIGHWAY 285
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City | LA JARA
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State | CO
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Zip | 81140
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Country | US
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Telephone | 719-274-5121
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Fax | 719-274-6003
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Authorized Official
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Title or Position | CCH CEO
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Name | KONNIE L. MARTIN
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Credential |
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Telephone | 719-587-1206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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