Organization
STATE OF COLORADO
Active
Parent organization
STATE OF COLORADO
Other names
TRINIDAD STATE NURSING HOME STAR CLUB ADULT DAY SERVICES PROGRAM
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF COLORADO
Authorized official
MR. LEE BURKHOLDER (NURSING HOME ADMINISTRATOR)
(719) 846-9291
Entity
Organization
Contact information
Practice address
409 BENEDICTA AVE, TRINIDAD STATE NURSING HOME, TRINIDAD, CO 81082-2004
(719) 845-2813
(719) 845-2807
Mailing address
409 BENEDICTA AVE, TRINIDAD STATE NURSING HOME STAR CLUB, TRINIDAD, CO 81082-2004
(719) 845-2813
(719) 845-2807
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
020796
CO
343900000X
Non-emergency Medical Transport (VAN)
020796
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05654058
—
CO
Enumeration date
04/22/2008
Last updated
09/26/2008
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