Ioof Grand Lodge of Colorado

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

23C967 Issued in CO

Legal business name

IOOF GRAND LODGE OF COLORADO

Practice address

1020 N 15TH St
Canon City, CO 81212-2344

Phone

(719) 275-7451

NPI assigned

Mar 11, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dennis G Prather

Title

Executive Director

Phone

(719) 275-7451

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Friendship House At The Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher J Buchanan, MD

  • Internal Medicine Physician
  • Canon City, CO
  • NPI 1245227040
  NPD (past)
• Sylvia Raye Strickland, LCSW

  • Clinical Social Worker
  • Canon City, CO
  • NPI 1134380272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236729600000",
    "number": "1073754693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 PHELPS AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124650",
            "telephone_number": "719-275-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122344",
            "telephone_number": "719-275-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOOF GRAND LODGE OF COLORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-11",
        "last_updated": "2009-03-11",
        "status": "A",
        "authorized_official_last_name": "PRATHER",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-275-7451",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "23C967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23C967",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendship House At The Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie Marie Huett, COTA
• Huh Inc
• Alicia Hurst, PHARMD
• Kimberly Hyde
• Internal Medicine of Canon City, P.C.
• Brianne Ireland
• Amber Irving, LPC
• Rebecca Paul Ivins, DMD
• Pamela Sue Jackson, MT-BC, NMT
• Yasha Jaffuel

• Assisted Living Facility in Canon City, CO
• Providers in Canon City, CO by specialty
• Assisted Living Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.