Healthcare Provider Details

I. General information

NPI: 1639666175
Provider Name (Legal Business Name): OPEN MOBILE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 IRIS AVE
BOULDER CO
80304-2433
US

IV. Provider business mailing address

2709 IRIS AVE
BOULDER CO
80304-2433
US

V. Phone/Fax

Practice location:
  • Phone: 720-893-0130
  • Fax:
Mailing address:
  • Phone: 720-893-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number905830
License Number StateCO

VIII. Authorized Official

Name: ABIGAIL ODOM
Title or Position: OWNER
Credential: RDH, OMT
Phone: 720-893-0130