Provider Demographics
NPI:1215315577
Name:HOME CARE OF GRAND JUNCTION LLC
Entity type:Organization
Organization Name:HOME CARE OF GRAND JUNCTION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-349-9050
Mailing Address - Street 1:2764 COMPASS DR., SUITE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8755
Mailing Address - Country:US
Mailing Address - Phone:970-245-7481
Mailing Address - Fax:970-245-7481
Practice Address - Street 1:2764 COMPASS DR., SUITE 105
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8755
Practice Address - Country:US
Practice Address - Phone:970-245-7481
Practice Address - Fax:970-245-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10H563253Z00000X
CO04X818253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21281386Medicaid