Provider Demographics
NPI:1396152641
Name:COLORADO PLAINS HOME HEALTH LLC
Entity type:Organization
Organization Name:COLORADO PLAINS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-336-1316
Mailing Address - Street 1:109 W LEE ST., #15
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052
Mailing Address - Country:US
Mailing Address - Phone:719-336-1316
Mailing Address - Fax:719-336-1318
Practice Address - Street 1:109 W LEE ST., #15
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-1316
Practice Address - Fax:719-336-1318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RYON MEDICAL & ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04M124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO067540OtherMEDICARE PTAN