Provider Demographics
NPI:1104268465
Name:WRAY COMMUNITY LONG TERM CARE INC
Entity type:Organization
Organization Name:WRAY COMMUNITY LONG TERM CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-332-2203
Mailing Address - Street 1:1017 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-1420
Mailing Address - Country:US
Mailing Address - Phone:970-332-2203
Mailing Address - Fax:970-332-4800
Practice Address - Street 1:360 CANYON RIDGE DR
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-8947
Practice Address - Country:US
Practice Address - Phone:970-332-4811
Practice Address - Fax:970-332-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility