Provider Demographics
NPI:1548704729
Name:BACA COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:BACA COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-523-4131
Mailing Address - Street 1:772 COLORADO ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1456
Mailing Address - Country:US
Mailing Address - Phone:719-523-4131
Mailing Address - Fax:719-523-4820
Practice Address - Street 1:772 COLORADO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1456
Practice Address - Country:US
Practice Address - Phone:719-523-4131
Practice Address - Fax:719-523-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04138657251B00000X, 372600000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04138657Medicaid