Organization
STATE OF COLORADO
Active
Parent organization
STATE OF COLORADO
Other names
Trinidad State Nursing Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF COLORADO
Authorized official
MR. LEE S. BURKHOLDER NHA (ADMINISTRATOR)
(719) 845-2818
Entity
Organization
Contact information
Practice address
409 BENEDICTA AVE, TRINIDAD, CO 81082-2004
(719) 846-9291
(719) 845-2802
Mailing address
409 BENEDICTA AVE, TRINIDAD, CO 81082-2004
(719) 846-9291
(719) 845-2802
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
020796
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04140687
—
CO
05
—
04143418
—
CO
05
—
05654058
—
CO
Enumeration date
09/27/2005
Last updated
09/26/2008
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