Jason Keith Holt

Individual provider Active NPI Case Manager/Care Coordinator · Las Animas, CO

NPI 1679902001 · NPPES record last updated Nov 6, 2013

Key facts

NPI
1679902001
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
License
ACB.0007699 (CO)
Practice address
30999 County Road 15
Las Animas, CO 81054-9499
Phone
(719) 662-1105
Fax
(719) 456-0109
NPI assigned
Nov 6, 2013
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
ACB.0007699COMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Coalition for the Homeless Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X ACB.0007699 CO Yes

Addresses

Primary practice location

30999 County Road 15
Las Animas, CO 81054-9499

Mailing address

1101 Grace Ave
La Junta, CO 81050-3119
Phone (719) 468-2734

Other providers in Las Animas, CO

All providers in Las Animas, CO · Case Manager/Care Coordinator in Colorado

Sources for this page

Verify at the official NPI Registry.