Provider Demographics
NPI:1053300640
Name:FOWLER HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:FOWLER HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-263-4234
Mailing Address - Street 1:221 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CO
Mailing Address - Zip Code:81039-1201
Mailing Address - Country:US
Mailing Address - Phone:719-263-4234
Mailing Address - Fax:
Practice Address - Street 1:221 2ND ST
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CO
Practice Address - Zip Code:81039-1201
Practice Address - Country:US
Practice Address - Phone:719-263-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0058314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05655626Medicaid
CO065360Medicare Oscar/Certification