NPIMap

Organization Active NPI

State of Colorado

Doing business as Trinidad State Nursing Home Star Club Adult Day Services Program

  • Adult Day Care Clinic/Center
  • Trinidad, CO
National Provider Identifier
1386818383
Registry record updated Sep 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
020796 Issued in CO
Legal business name
STATE OF COLORADO
Doing business as
Trinidad State Nursing Home Star Club Adult Day Services Program
Practice address
409 Benedicta Ave
Trinidad State Nursing Home
Trinidad, CO 81082-2004
Phone
(719) 845-2813
Fax
(719) 845-2807
NPI assigned
Apr 22, 2008
Last updated
Sep 26, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF COLORADOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2008

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

Authorized official

Name
Mr. Lee Burkholder
Title
Nursing Home Administrator
Phone
(719) 846-9291

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 020796 CO Primary
Non-emergency Medical Transport (VAN) 343900000X 020796 CO

Addresses

Primary practice location

409 Benedicta Ave
Trinidad State Nursing Home
Trinidad, CO 81082-2004

Mailing address

409 Benedicta Ave
Trinidad State Nursing Home Star Club
Trinidad, CO 81082-2004
Phone (719) 845-2813

Other identifiers 1

IdentifierTypeStateIssuer
05654058MedicaidCO

Other names 1

  • TRINIDAD STATE NURSING HOME STAR CLUB ADULT DAY SERVICES PROGRAM Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colorado State Veterans Nursing Home103 organizations share this tax ID, including this one
Part of
Colorado State Veterans Nursing Home

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222387200000",
    "number": "1386818383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 BENEDICTA AVE",
            "address_2": "TRINIDAD STATE NURSING HOME STAR CLUB",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822004",
            "telephone_number": "719-845-2813",
            "fax_number": "719-845-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 BENEDICTA AVE",
            "address_2": "TRINIDAD STATE NURSING HOME",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822004",
            "telephone_number": "719-845-2813",
            "fax_number": "719-845-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF COLORADO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF COLORADO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-09-26",
        "status": "A",
        "authorized_official_last_name": "BURKHOLDER",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "719-846-9291",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "CO",
            "license": "020796",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "CO",
            "license": "020796",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05654058",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRINIDAD STATE NURSING HOME STAR CLUB ADULT DAY SERVICES PROGRAM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trinidad, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.