Healthcare Provider Details

I. General information

NPI: 1861249500
Provider Name (Legal Business Name): PIKES PEAK HOSPICE AND PALLIATIVE CARE GUIDE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 TENDERFOOT HILL ST
COLORADO SPRINGS CO
80906-3998
US

IV. Provider business mailing address

8289 E LOWRY BLVD
DENVER CO
80230-7256
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3400
  • Fax:
Mailing address:
  • Phone: 303-398-6222
  • 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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY BOWEN
Title or Position: CEO
Credential:
Phone: 303-398-6226