Provider Demographics
NPI:1912746744
Name:SANGRE DE CRISTO COMMUNITY CARE
Entity type:Organization
Organization Name:SANGRE DE CRISTO COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGING
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:719-369-2902
Mailing Address - Fax:719-542-1486
Practice Address - Street 1:1920 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1764
Practice Address - Country:US
Practice Address - Phone:719-542-0032
Practice Address - Fax:719-542-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty