Healthcare Provider Details

I. General information

NPI: 1316629389
Provider Name (Legal Business Name): PIKES PEAK HOSPICE AND PALLIATIVE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE FL 6
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2550 TENDERFOOT HILL ST
COLORADO SPRINGS CO
80906-3998
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-6262
  • Fax:
Mailing address:
  • Phone: 719-633-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM J BOWEN
Title or Position: CEO
Credential:
Phone: 303-398-6203