Healthcare Provider Details

I. General information

NPI: 1194116632
Provider Name (Legal Business Name): ANTONINA HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 S HOLLY CIR STE 200
CENTENNIAL CO
80112-1066
US

IV. Provider business mailing address

6970 S HOLLY CIR STE 200
CENTENNIAL CO
80112-1066
US

V. Phone/Fax

Practice location:
  • Phone: 720-276-1705
  • Fax:
Mailing address:
  • Phone: 720-276-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04K566
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04D715
License Number StateCO

VIII. Authorized Official

Name: YULIA SUSINA
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-500-2075