Provider Demographics
NPI:1588089015
Name:IMMACULATE CARE OPTIMAL NURSING HOME & HEALTH LLC
Entity type:Organization
Organization Name:IMMACULATE CARE OPTIMAL NURSING HOME & HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HISSONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-480-5086
Mailing Address - Street 1:2821 S. PARKER RD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:720-480-5086
Mailing Address - Fax:720-535-7221
Practice Address - Street 1:2821 S. PARKER RD.
Practice Address - Street 2:SUITE 177
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-480-5086
Practice Address - Fax:720-535-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty