Provider Demographics
NPI:1912123522
Name:OTERO COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:OTERO COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARRICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-383-3168
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-0494
Mailing Address - Country:US
Mailing Address - Phone:719-383-3168
Mailing Address - Fax:719-383-3150
Practice Address - Street 1:13 W 3RD ST
Practice Address - Street 2:ROOM 102
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1536
Practice Address - Country:US
Practice Address - Phone:719-383-3168
Practice Address - Fax:719-383-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06200455Medicaid