Healthcare Provider Details

I. General information

NPI: 1770133829
Provider Name (Legal Business Name): GLIMMER OF HOPE HOME HEALTH CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 MESCALERO DR
COLORADO SPRINGS CO
80915-3110
US

IV. Provider business mailing address

6842 MESCALERO DR
COLORADO SPRINGS CO
80915-3110
US

V. Phone/Fax

Practice location:
  • Phone: 719-331-2610
  • Fax:
Mailing address:
  • Phone: 719-331-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA LYNN RUSSELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-331-2610