Healthcare Provider Details

I. General information

NPI: 1457802522
Provider Name (Legal Business Name): 5280 HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 LEHMAN DR STE 201
COLORADO SPRINGS CO
80918-8404
US

IV. Provider business mailing address

6208 LEHMAN DR STE 201
COLORADO SPRINGS CO
80918-8404
US

V. Phone/Fax

Practice location:
  • Phone: 719-300-4455
  • Fax: 719-300-4466
Mailing address:
  • Phone: 719-300-4455
  • Fax: 719-300-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04Z790
License Number StateCO

VIII. Authorized Official

Name: YEVGENIY MAGAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-300-4455