Organization
CHINOOK HEALTHCARE IN
Active
Other names
Chinook LTC
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON HODGE (PRESIDENT)
(720) 458-4887
Entity
Organization
Contact information
Practice address
275 WANEKA PKWY STE 10, LAFAYETTE, CO 80026-8857
(720) 458-4887
(720) 890-6144
Mailing address
275 WANEKA PKWY, SUITE 10, LAFAYETTE, CO 80026-8873
(720) 458-4887
(720) 890-6144
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
1680000058
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177389
PK
—
05
—
54930022
—
CO
Enumeration date
05/08/2018
Last updated
05/08/2018
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