Healthcare Provider Details

I. General information

NPI: 1053611038
Provider Name (Legal Business Name): HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 N UNION BLVD SUITE #204
COLORADO SPRINGS CO
80918-2000
US

IV. Provider business mailing address

PO BOX 88393
COLORADO SPRINGS CO
80908-8393
US

V. Phone/Fax

Practice location:
  • Phone: 719-535-0476
  • Fax: 719-494-0349
Mailing address:
  • Phone: 719-535-0476
  • Fax: 719-494-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04J382
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04J382
License Number StateCO

VIII. Authorized Official

Name: MS. ELIZABETH F. LEE
Title or Position: OWNER
Credential:
Phone: 719-330-6882