Provider Demographics
NPI:1386120707
Name:SANGRE DE CRISTO COMMUNITY CARE
Entity type:Organization
Organization Name:SANGRE DE CRISTO COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-0032
Mailing Address - Street 1:1920 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1764
Mailing Address - Country:US
Mailing Address - Phone:719-542-0032
Mailing Address - Fax:719-542-1486
Practice Address - Street 1:207 COLORADO AVE STE B
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1517
Practice Address - Country:US
Practice Address - Phone:719-254-3661
Practice Address - Fax:719-254-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04026U251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04026UOtherSTATE LICENSE