MEDICARE: QUEEN'S CARE IN HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	04F397	CO
2	251E00000X	Home Health Agency	04E902	CO
3	343900000X	Non-emergency Medical Transport (VAN)	B-10054	CO
4	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417261520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN'S CARE IN HOME INC.

Provider Business Mailing Address
First Line	:	5054 BILLINGS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-4323
Country	:	US
Telephone Number	:	303-371-6588
Fax Number	:	303-371-6637

Provider Business Practice Location Address
First Line	:	5054 BILLINGS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-4323
Country	:	US
Telephone Number	:	303-371-6588
Fax Number	:	303-371-6637

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. QUEEN MOSES
Credential	:
Telephone Number	:	303-371-6588

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	11/04/2016

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