Provider Demographics
NPI:1881627644
Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Entity type:Organization
Organization Name:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-641-0704
Mailing Address - Street 1:1498 W TOMICHI AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3703
Mailing Address - Country:US
Mailing Address - Phone:970-641-4254
Mailing Address - Fax:970-641-1826
Practice Address - Street 1:1498 W TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3703
Practice Address - Country:US
Practice Address - Phone:970-641-4254
Practice Address - Fax:970-641-1826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNNISON VALLEY HEALTH SENIOR CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1178315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
061537Medicare Oscar/Certification