1255308771 NPI number — INTERIM HEALTHCARE OF GREATER DENVER INC

Table of content: (NPI 1255308771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255308771 NPI number — INTERIM HEALTHCARE OF GREATER DENVER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF GREATER DENVER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255308771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W HAMPDEN AVE STE 925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80110-2477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-789-4686
Provider Business Mailing Address Fax Number:
303-789-1644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W HAMPDEN AVE STE 925
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80110-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-789-4686
Provider Business Practice Location Address Fax Number:
303-789-1644
Provider Enumeration Date:
03/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
303-789-4686

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04T695 . This is a "STATE OF COLORADO HOME CARE AGENCY MEDICAL CLASS A LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 85480240 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".