Healthcare Provider Details

I. General information

NPI: 1346854171
Provider Name (Legal Business Name): COLORADO SPRINGS CO CAREGIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 DELMONICO DR STE 201
COLORADO SPRINGS CO
80919-1892
US

IV. Provider business mailing address

209 S 28TH ST
WACO TX
76710-7415
US

V. Phone/Fax

Practice location:
  • Phone: 719-627-4410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AVERY LAIN
Title or Position: VP BUSINESS DEVELOPMENT
Credential:
Phone: 817-991-7836