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General NPI Number Information
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NPI Number | 1992243299
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Entity Type | Organization
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Legal Business Name | HUERFANO LAS ANIMAS AREA COUNCIL OF GOVERNMENTS
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 625 N POLK AVE
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City | WALSENBURG
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State | CO
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Zip | 81089-1549
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Country | US
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Telephone | 719-738-2205
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Fax | 719-738-6898
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Provider Business Mailing Address
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Address Line | 625 N POLK AVE
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City | WALSENBURG
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State | CO
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Zip | 81089-1549
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Country | US
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Telephone | 719-738-2205
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Fax | 719-738-6898
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WALTER BOULDEN
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Credential |
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Telephone | 719-845-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 10F196
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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