Provider Demographics
NPI:1194116632
Name:ANTONINA HEALTH CARE LLC
Entity type:Organization
Organization Name:ANTONINA HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-500-2075
Mailing Address - Street 1:6970 S HOLLY CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1066
Mailing Address - Country:US
Mailing Address - Phone:720-276-1705
Mailing Address - Fax:
Practice Address - Street 1:6970 S HOLLY CIR STE 200
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1066
Practice Address - Country:US
Practice Address - Phone:720-276-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04K566251E00000X
CO04D715253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care