Provider Demographics
NPI:1447717418
Name:VALLEY CITIZENS' FOUNDATION FOR HEALTHCARE, INC
Entity type:Organization
Organization Name:VALLEY CITIZENS' FOUNDATION FOR HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN SEC/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-657-4102
Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8719
Mailing Address - Country:US
Mailing Address - Phone:719-657-4102
Mailing Address - Fax:719-657-4064
Practice Address - Street 1:1033 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1737
Practice Address - Country:US
Practice Address - Phone:719-628-0118
Practice Address - Fax:719-628-0119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY CITIZENS' FOUNDATION FOR HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-26
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy