Provider Demographics
NPI:1114386448
Name:THE COACH HOME CARE AND CONSULTING AGENCY, LLC
Entity type:Organization
Organization Name:THE COACH HOME CARE AND CONSULTING AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIME
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:719-231-2152
Mailing Address - Street 1:1900 E PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5850
Mailing Address - Country:US
Mailing Address - Phone:719-391-4444
Mailing Address - Fax:719-390-6895
Practice Address - Street 1:1900 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5850
Practice Address - Country:US
Practice Address - Phone:719-391-4444
Practice Address - Fax:719-390-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04M594251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96732369Medicaid