NPIMap

Organization Active NPI

Lutheran Hospital Association of the San Luis Valley

Doing business as SLV Health La Jara Clinic

  • Rural Health Clinic/Center
  • La Jara, CO
National Provider Identifier
1942511019
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
011020 Issued in CO
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
SLV Health La Jara Clinic
Practice address
509 Main Street
La Jara, CO 81140
Phone
(719) 274-5000
Fax
(719) 274-4111
NPI assigned
Jun 23, 2010
Last updated
Aug 6, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • SLV Health La Jara Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942511019. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Nov 27, 1937 in CO
Enrollment address
509 Main Street
La Jara, CO 81140-9410
Related CCNs
060008

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

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0939924San Luis Valley Health - la Jara Clinic509 Main St, La Jara, CO 81140Provider-performed microscopyFeb 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
San Luis Valley Reg Med Ctr11 organizations share this tax ID, including this one
Part of
San Luis Valley Reg Med Ctr

Other organizations with this tax ID 10

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

Ownership & related parties

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 DirectorBoard President Jul 1, 2013
Christine Hettinger Hunt Individual Corporate OfficerChief Nursing Officer Jan 1, 2019
Shane Mortensen Individual Corporate OfficerChief 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 OfficerCmo Jan 1, 2019
W-2 Managing EmployeeCmo Jan 1, 2019
Konnie Martin Individual Corporate OfficerChief Executive Officer Jul 1, 2013
W-2 Managing EmployeeChief Executive Officer Jul 1, 2013

Owners & managing parties with NPI records 7

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

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 HealthLa Jara, CO, CCN 061308 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Conejos County Hospital Swing BedLa Jara, CO, CCN 06Z308 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Antonito ClinicAntonito, CO, CCN 063992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
Lutheran Hospital Association of the San Luis ValleyMonte Vista, CO, CCN 068523 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 2, 2011

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1942511019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19021 US HIGHWAY 285",
            "city": "LA JARA",
            "state": "CO",
            "postal_code": "811409410",
            "telephone_number": "719-274-5000",
            "fax_number": "719-274-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MAIN STREET",
            "city": "LA JARA",
            "state": "CO",
            "postal_code": "81140",
            "telephone_number": "719-274-5000",
            "fax_number": "719-274-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "enumeration_date": "2010-06-23",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "GARVIN",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "CCH CEO",
        "authorized_official_telephone_number": "719-274-6004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CO",
            "license": "011020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLV Health La Jara Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Jara, CO

Sources for this page

Verify at the official NPI Registry.