MEDICARE: CENTER HOME CARE 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

General Provider Information

NPI Number	:	1578017547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER HOME CARE INC.

Provider Business Mailing Address
First Line	:	721 4TH ST STE A
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1846
Country	:	US
Telephone Number	:	303-990-9026
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 4TH ST STE A
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1846
Country	:	US
Telephone Number	:	303-990-9026
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FAUSTINO GARCIA
Credential	:
Telephone Number	:	303-990-9026

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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