Provider Demographics
NPI:1912239245
Name:HOSPICE & PALLIATIVE CARE OF NORTHERN COLORADO
Entity type:Organization
Organization Name:HOSPICE & PALLIATIVE CARE OF NORTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-475-0053
Mailing Address - Street 1:2726 W 11TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5408
Mailing Address - Country:US
Mailing Address - Phone:970-352-8487
Mailing Address - Fax:
Practice Address - Street 1:2726 W 11TH STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5408
Practice Address - Country:US
Practice Address - Phone:970-352-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE & PALLIATIVE CARE OF NORTHERN COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170366315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
061503Medicare PIN