Organization
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Active
Parent organization
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Other names
SLV Health Antonito Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Authorized official
KONNIE L. MARTIN (CCH CEO)
(719) 587-1206
Entity
Organization
Contact information
Practice address
115 MAIN STREET, ANTONITO, CO 81120-0087
(719) 376-2308
(719) 376-2395
Mailing address
19021 US HIGHWAY 285, LA JARA, CO 81140
(719) 274-5121
(719) 274-6003
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93388560
—
CO
Enumeration date
03/20/2006
Last updated
11/24/2020
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