Healthcare Provider Details

I. General information

NPI: 1306872908
Provider Name (Legal Business Name): ANAM CHARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 7TH ST
BOULDER CO
80302-5026
US

IV. Provider business mailing address

1910 7TH ST
BOULDER CO
80302-5026
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-0046
  • Fax: 303-443-0994
Mailing address:
  • Phone: 303-444-0046
  • Fax: 303-443-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1199
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier20472307
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: PEGGY QUINN
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-444-0046