=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972585784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLORADO WEST HEALTHCARE SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 01/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 N 12TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-2980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-256-6225
-----------------------------------------------------
Fax | 970-256-6548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 N 12TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-2980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-256-6225
-----------------------------------------------------
Fax | 970-256-6548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, HOME HEALTH
-----------------------------------------------------
Name | MRS. KRISTIN GUNDT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-256-6225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 067298
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------