Provider Demographics
NPI:1396109583
Name:COLORADO PERSONAL HOME HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:COLORADO PERSONAL HOME HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-435-0493
Mailing Address - Street 1:2620 S PARKER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1621
Mailing Address - Country:US
Mailing Address - Phone:720-435-0493
Mailing Address - Fax:303-873-7149
Practice Address - Street 1:2620 S PARKER RD STE 190
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1621
Practice Address - Country:US
Practice Address - Phone:720-435-0493
Practice Address - Fax:303-873-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10P633251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17083842Medicaid