MEDICARE: GRAND VALLEY BIRTH CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife
2	261QB0400X	Birthing Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619859592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND VALLEY BIRTH CENTER LLC

Provider Business Mailing Address
First Line	:	1817 JESSUP DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2550
Country	:	US
Telephone Number	:	866-218-5769
Fax Number	:	866-218-5769

Provider Business Practice Location Address
First Line	:	360 W PARK DR STE 105
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1619
Country	:	US
Telephone Number	:	866-218-5769
Fax Number	:	866-218-5769

Authorized Official
Title or Position	:	OWNER
Name	:	ALTHEA HRDLICHKA
Credential	:
Telephone Number	:	866-218-5769

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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Directions to “GRAND VALLEY BIRTH CENTER LLC ” Practice Location

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