MEDICARE: HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251K00000X	Public Health or Welfare Agency
2	261QD0000X	Dental Clinic/Center
3	261QH0100X	Health Service 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	:	1821092495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY

Provider Business Mailing Address
First Line	:	120 BRISTLECONE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2031
Country	:	US
Telephone Number	:	970-224-5209
Fax Number	:	970-472-0440

Provider Business Practice Location Address
First Line	:	425 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2864
Country	:	US
Telephone Number	:	970-224-5209
Fax Number	:	970-472-0440

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	A LORRAINE HAYWOOD
Credential	:
Telephone Number	:	970-224-5209

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/03/2022

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1336858216 — HEALTH SERVICES DISTRICT OF NORTHERN LARIMER COUNTY
Practice Location Address:

425 W MULBERRY ST
FORT COLLINS, CO
80521-2864

Practice Phone: 970-224-5209
Practice Fax:

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