Healthcare Provider Details

I. General information

NPI: 1750406138
Provider Name (Legal Business Name): PROFESSIONAL HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 47TH ST SUITE 100
BOULDER CO
80301-1880
US

IV. Provider business mailing address

1629 HARVARD ST
LONGMONT CO
80503-2219
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-1981
  • Fax: 720-864-2839
Mailing address:
  • Phone: 720-494-0190
  • Fax: 720-864-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04138020
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerOTHER HCBS

VIII. Authorized Official

Name: SHERYL A BELLINGER
Title or Position: PRESIDENT
Credential:
Phone: 720-530-5492