Organization
MARILLAC CLINIC, INC
Active
Other names
PrimeHealthplus
Organization subpart
No
Provider details
NPI number
Authorized official
LATA RAMACHANDRAN (CEO)
(970) 200-1600
Entity
Organization
Contact information
Practice address
2139 N 12TH ST STE 2, GRAND JUNCTION, CO 81501-2910
(970) 200-1600
(970) 692-8301
Mailing address
2333 N 6TH ST, GRAND JUNCTION, CO 81501-2001
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/25/2022
Last updated
08/05/2025
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