Provider Demographics
NPI:1306303680
Name:A CIRCLE OF CARE COLORADO, LLC.
Entity type:Organization
Organization Name:A CIRCLE OF CARE COLORADO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:719-476-0205
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:602-508-1883
Mailing Address - Fax:602-385-4941
Practice Address - Street 1:1365 GARDEN OF THE GODS RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3419
Practice Address - Country:US
Practice Address - Phone:719-476-0205
Practice Address - Fax:719-476-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000175258Medicaid