1922472406 NPI number — FULL SPECTRUM HOME CARE SERVICES

Table of content: (NPI 1922472406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922472406 NPI number — FULL SPECTRUM HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULL SPECTRUM HOME CARE SERVICES
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:
1922472406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3116 VAIL PASS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80917-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3116 VAIL PASS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80917-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-291-8241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-291-8241

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A1 . This is a "KAISER-PERMANENTE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "AFLAC" identifier . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "HUMANA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "UNITED HEALTH CARE INSURANCE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "UNITED HEALTH CARE INSURANCE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "METLIFE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "METLIFE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A1 . This is a "AFLAC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "BLUE CROSS BLUE SHIELD INSURANCE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 . This is a "KAISER-PERMANENTE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: A4 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: A1 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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