Healthcare Provider Details

I. General information

NPI: 1740091677
Provider Name (Legal Business Name): BE THE PART HOMECARE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6746 EDMONDSTOWN DR
COLORADO SPRINGS CO
80923-7704
US

IV. Provider business mailing address

6746 EDMONDSTOWN DR
COLORADO SPRINGS CO
80923-7704
US

V. Phone/Fax

Practice location:
  • Phone: 719-678-1078
  • Fax:
Mailing address:
  • Phone: 719-678-1078
  • 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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH OBIERO
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 719-678-1078