Provider Demographics
NPI:1962736561
Name:RIO GRANDE INN, INC.
Entity type:Organization
Organization Name:RIO GRANDE INN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-516-1404
Mailing Address - Street 1:1004 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3326
Mailing Address - Country:US
Mailing Address - Phone:970-516-1404
Mailing Address - Fax:970-516-1400
Practice Address - Street 1:39 CALLE MILLER
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9756
Practice Address - Country:US
Practice Address - Phone:719-274-3311
Practice Address - Fax:719-274-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75825571Medicaid