Healthcare Provider Details

I. General information

NPI: 1588477616
Provider Name (Legal Business Name): BANNER HOME CARE COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 70TH AVE STE 110
GREELEY CO
80634-4628
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-6222
  • Fax: 970-810-6338
Mailing address:
  • Phone: 602-747-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES COTE
Title or Position: VP AMBULATORY SERVICES
Credential:
Phone: 602-747-4000