Healthcare Provider Details

I. General information

NPI: 1114386448
Provider Name (Legal Business Name): THE COACH HOME CARE AND CONSULTING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E PIKES PEAK AVE
COLORADO SPRINGS CO
80909-5850
US

IV. Provider business mailing address

1900 E PIKES PEAK AVE
COLORADO SPRINGS CO
80909-5850
US

V. Phone/Fax

Practice location:
  • Phone: 719-391-4444
  • Fax: 719-390-6895
Mailing address:
  • Phone: 719-391-4444
  • Fax: 719-390-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04M594
License Number StateCO

VIII. Authorized Official

Name: MR. CHRISTEL AIME
Title or Position: PRESIDENT
Credential: RN-BSN
Phone: 719-231-2152