Healthcare Provider Details

I. General information

NPI: 1114630852
Provider Name (Legal Business Name): COLUMBINE POUDRE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CENTRE AVE STE 2
FORT COLLINS CO
80526-6046
US

IV. Provider business mailing address

802 W DRAKE RD STE 101
FORT COLLINS CO
80526-5567
US

V. Phone/Fax

Practice location:
  • Phone: 970-482-5096
  • Fax: 970-224-2518
Mailing address:
  • Phone: 970-482-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: BARRY K FANCHER
Title or Position: CFO
Credential:
Phone: 970-482-0198