Provider Demographics
NPI:1083831010
Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Entity type:Organization
Organization Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-642-4807
Mailing Address - Street 1:1498 W TOMICHI AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3703
Mailing Address - Country:US
Mailing Address - Phone:970-641-4254
Mailing Address - Fax:970-641-7239
Practice Address - Street 1:1498 W TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3703
Practice Address - Country:US
Practice Address - Phone:970-641-4254
Practice Address - Fax:970-641-7239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNNISON LIVING COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO040904251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05700786Medicaid
CO067191Medicare ID - Type Unspecified