MEDICARE: HOMEPRIDE, LLC

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1679047104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEPRIDE, LLC

Provider Business Mailing Address
First Line	:	4833 FRONT ST UNIT 455
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7902
Country	:	US
Telephone Number	:	303-558-5225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 INDUSTRIAL WAY # B3
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2803
Country	:	US
Telephone Number	:	303-558-5225
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. MATTHEW COLLIGAN
Credential	:
Telephone Number	:	719-499-1750

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/17/2019

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Directions to “HOMEPRIDE, LLC ” Practice Location

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