1447517826 NPI number — LITTLE HOME HEALTH ON THE PRAIRIE

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 1447517826 NPI number — LITTLE HOME HEALTH ON THE PRAIRIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE HOME HEALTH ON THE PRAIRIE
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:
1447517826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1243
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80828-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-775-8599
Provider Business Mailing Address Fax Number:
719-775-8589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 COLORADO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80828-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-775-8599
Provider Business Practice Location Address Fax Number:
719-775-8589
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROSLER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-775-8599

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  Z00790 , 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)





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