1295198067 NPI number — SOUTHERN COLORADO HEALTH & REHAB

Table of content: (NPI 1295198067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295198067 NPI number — SOUTHERN COLORADO HEALTH & REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN COLORADO HEALTH & REHAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295198067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59903-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-756-0134
Provider Business Mailing Address Fax Number:
406-309-2579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 W PUEBLO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-542-0589
Provider Business Practice Location Address Fax Number:
719-542-0119
Provider Enumeration Date:
03/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STIMAC
Authorized Official First Name:
BLAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
406-756-1128

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com