Organization
MARILLAC CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATA RAMACHANDRAN (CEO)
(970) 200-1600
Entity
Organization
Contact information
Practice address
360 W PARK DR, GRAND JUNCTION, CO 81505-1618
(970) 200-1600
(970) 692-8301
Mailing address
2333 N 6TH ST, GRAND JUNCTION, CO 81501-2001
(970) 200-1600
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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