Healthcare Provider Details

I. General information

NPI: 1578038436
Provider Name (Legal Business Name): CAPITOL PEAK HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16372 E FREMONT AVE UNIT 11 BLDG 4
AURORA CO
80016
US

IV. Provider business mailing address

16372 E FREMONT AVE UNIT 11 BLDG 4
AURORA CO
80016
US

V. Phone/Fax

Practice location:
  • Phone: 720-980-3067
  • Fax:
Mailing address:
  • Phone: 720-980-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: EUGENE MLODIK
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 720-980-3067