| Organization Name: | STATE OF COLORADO |
| NPI Number: | 1386818383 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LEE BURKHOLDER (NURSING HOME ADMINISTRATOR) |
| Mailing Address: | 409 Benedicta Ave Trinidad State Nursing Home Trinidad |
| State: | CO US |
| Postal Code: | 810822004 |
| Phone Number: | 7198452813 |
| Fax Number: | 7198452807 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 09/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | 020796 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |