State of Colorado

NPI #1386818383 in Trinidad, Colorado

Provider Information

NPI Number
1386818383
Entity Type
Organization
Organization Name
State of Colorado
Subpart
Yes (part of a larger organization)
Parent Organization
STATE OF COLORADO
Primary Specialty
Clinic/Center - Adult Day Care
Enumeration Date
Apr 22, 2008
Last Updated
Sep 26, 2008

Practice Location

Address
409 BENEDICTA AVE
Address 2
TRINIDAD STATE NURSING HOME
ZIP Code
81082-2004
Phone
(719) 845-2813

Authorized Official

Name
MR. LEE BURKHOLDER
Title
NURSING HOME ADMINISTRATOR
Phone
(719) 846-9291

Specialties & Taxonomy Codes

Specialty
Non-emergency Medical Transport (VAN)
Clinic/Center - Adult Day CareAdult Day Care

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