1598764656 NPI number — PROSPECT HOME CARE-HOSPICE, INC.

Table of content: MS. MAUREEN THERESA SHEEHAN MSW LCSW (NPI 1003010034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598764656 NPI number — PROSPECT HOME CARE-HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSPECT HOME CARE-HOSPICE, 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:
6
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:
1598764656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16222 HIGHWAY 24
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
WOODLAND PARK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-687-0549
Provider Business Mailing Address Fax Number:
719-687-8558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16222 HIGHWAY 24
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
WOODLAND PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-687-0549
Provider Business Practice Location Address Fax Number:
719-687-8558
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARROWMAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
719-687-0549

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0396 , 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: 05800040 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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