Provider Demographics
NPI:1891762316
Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RINGLING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-632-9900
Mailing Address - Street 1:720 N MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3020
Mailing Address - Country:US
Mailing Address - Phone:719-545-1184
Mailing Address - Fax:719-545-1746
Practice Address - Street 1:720 N MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3020
Practice Address - Country:US
Practice Address - Phone:719-545-1184
Practice Address - Fax:719-545-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 251E00000X
CO040680253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO040680OtherCOLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
CO42137063Medicaid
CO067337Medicare PIN