Provider Demographics
NPI:1306939970
Name:INTERIM HEALTHCARE OF WESTERN COLORADO INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF WESTERN COLORADO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-3166
Mailing Address - Street 1:2764 COMPASS DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8735
Mailing Address - Country:US
Mailing Address - Phone:970-241-3166
Mailing Address - Fax:970-241-2757
Practice Address - Street 1:2764 COMPASS DR STE 225
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8735
Practice Address - Country:US
Practice Address - Phone:970-241-3166
Practice Address - Fax:970-241-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05701180Medicaid
CO04182630Medicaid
CO05701180Medicaid