1992040786 NPI number — HOMEFRONT HEALTH AND OCCUPATIONAL MEDICINE LLC

Table of content: (NPI 1992040786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992040786 NPI number — HOMEFRONT HEALTH AND OCCUPATIONAL MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEFRONT HEALTH AND OCCUPATIONAL MEDICINE LLC
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:
1992040786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5321 WEST 1ST ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-515-6580
Provider Business Mailing Address Fax Number:
970-515-6581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 32ND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-515-6580
Provider Business Practice Location Address Fax Number:
970-515-6581
Provider Enumeration Date:
12/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CATON
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
720-308-5115

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  40441 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 40441 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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