Healthcare Provider Details

I. General information

NPI: 1609400407
Provider Name (Legal Business Name): PURE HEALTHCARE OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E FONTANERO ST STE 103
COLORADO SPRINGS CO
80907-7535
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 855-550-3358
  • Fax:
Mailing address:
  • Phone: 801-755-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL FRAGA
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 801-921-6325