Healthcare Provider Details

I. General information

NPI: 1184623977
Provider Name (Legal Business Name): COLUMBINE POUDRE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CENTRE AVE SUITE 2
FORT COLLINS CO
80526-6045
US

IV. Provider business mailing address

915 CENTRE AVE SUITE 2
FORT COLLINS CO
80526-6045
US

V. Phone/Fax

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

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. J. ROBERT WILSON
Title or Position: OWNER
Credential:
Phone: 970-482-0198