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Lutheran Hospital Association of the San Luis Valley

Organization Active NPI Rural Health Clinic/Center · La Jara, CO

NPI 1942511019 · NPPES record last updated Aug 6, 2013

Key facts

NPI
1942511019
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
011020 (CO)
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Practice address
509 Main Street
La Jara, CO 81140
Phone
(719) 274-5000
Fax
(719) 274-4111
NPI assigned
Jun 23, 2010
Organization subpart
Yes
Parent organization (as reported)
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY

Authorized official

Name
Mr. Henry Garvin
Title
CCH Ceo
Phone
(719) 274-6004

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 197

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

View all 197

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0939924San Luis Valley Health - la Jara Clinic
509 Main St, La Jara, CO 81140		Provider-performed microscopyFeb 2, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Rural health clinic certification: CCN 068513

Legal name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
SLV HEALTH LA JARA CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 10, 2010
Last certification
Sep 7, 2023
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2013 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Nov 27, 1937 in CO
Enrollment address
509 Main Street
La Jara, CO 81140-9410
Related CCNs
060008

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karla Hardesty
Individual 		Corporate Director
Board President		 Jul 1, 2013
Christine Hettinger Hunt
Individual 		Corporate Officer
Chief Nursing Officer		 Jan 1, 2019
Shane Mortensen
Individual 		Corporate Officer
Chief Financial Officer		 Jul 1, 2013
Lutheran Hospital Association of the San Luis Valley
Organization · Alamosa, CO
Non-profit 		5% Or Greater Direct Ownership Interest Jul 1, 2013 100%
Carmelo Hernandez
Individual 		Corporate Officer
Cmo		 Jan 1, 2019
W-2 Managing Employee
Cmo		 Jan 1, 2019
Konnie Martin
Individual 		Corporate Officer
Chief Executive Officer		 Jul 1, 2013
W-2 Managing Employee
Chief Executive Officer		 Jul 1, 2013

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Luis Valley Health
La Jara, CO · CCN 061308		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Conejos County Hospital Swing Bed
La Jara, CO · CCN 06Z308		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Antonito Clinic
Antonito, CO · CCN 063992		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
Lutheran Hospital Association of the San Luis Valley
Monte Vista, CO · CCN 068523		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 2, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130812000167 CO Part a Provider - Rural Health Clinic 4789589094 Practice locations: La Jara, CO

National Provider Directory

Tax ID family
San Luis Valley Reg Med Ctr (11 organizations share this tax ID)
Part of
San Luis Valley Reg Med Ctr

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 011020 CO Yes

Addresses

Primary practice location

509 Main Street
La Jara, CO 81140

Mailing address

19021 US Highway 285
La Jara, CO 81140-9410
Phone (719) 274-5000

Other identifiers

IdentifierTypeStateIssuer
55601359MedicaidCO
1376504092OtherCOPREVIOUS NPI NUMBER

Other names

  • SLV Health La Jara Clinic Doing business as

Other providers in La Jara, CO

All providers in La Jara, CO · Rural Health Clinic/Center in Colorado

Sources for this page

Verify at the official NPI Registry.