Provider Demographics
NPI:1174973796
Name:COUNTY OF GRAND
Entity type:Organization
Organization Name:COUNTY OF GRAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BRENE
Authorized Official - Last Name:BELEW-LADUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-725-3288
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:HOT SULPHUR SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80451-0264
Mailing Address - Country:US
Mailing Address - Phone:970-725-3288
Mailing Address - Fax:970-725-3438
Practice Address - Street 1:150 MOFFAT AVENUE
Practice Address - Street 2:
Practice Address - City:HOT SULPHUR SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80451
Practice Address - Country:US
Practice Address - Phone:970-725-3288
Practice Address - Fax:970-725-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101201253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04138814Medicaid