Healthcare Provider Details

I. General information

NPI: 1285209346
Provider Name (Legal Business Name): ELDER CARE INC. OF COLORADO SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W BROOKSIDE ST
COLORADO SPRINGS CO
80905-2105
US

IV. Provider business mailing address

225 W BROOKSIDE ST
COLORADO SPRINGS CO
80905-2105
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-6511
  • Fax: 719-632-0726
Mailing address:
  • Phone: 719-632-6511
  • Fax: 719-632-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY AARON PITUS
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-632-6511