Provider Demographics
NPI:1104897693
Name:EVANS ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VENCILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:719-524-4373
Mailing Address - Street 1:9351 BAR B RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-3390
Mailing Address - Country:US
Mailing Address - Phone:719-382-9141
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-524-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18334286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital