Healthcare Provider Details

I. General information

NPI: 1023955507
Provider Name (Legal Business Name): SOUTHRAY HOME SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 PRIMROSE DR
FORT COLLINS CO
80526-2127
US

IV. Provider business mailing address

2126 PRIMROSE DR
FORT COLLINS CO
80526-2127
US

V. Phone/Fax

Practice location:
  • Phone: 970-599-1465
  • Fax:
Mailing address:
  • Phone: 970-599-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: SERGIO GRANADOS
Title or Position: OPERATIONS MANAGER
Credential: GC
Phone: 970-214-4921