1003024514 NPI number — COLORADO SPIRIT HOME CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003024514 NPI number — COLORADO SPIRIT HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO SPIRIT HOME CARE
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:
1003024514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 E BETHANY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-695-8888
Provider Business Mailing Address Fax Number:
303-695-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10700 E BETHANY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-695-8888
Provider Business Practice Location Address Fax Number:
303-695-8881
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASIMOVA
Authorized Official First Name:
DILRABO
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
303-695-8888

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  10G509 , 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)

  • Identifier: 64100855 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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