Healthcare Provider Details

I. General information

NPI: 1598943342
Provider Name (Legal Business Name): ARK-VALLEY HOME & HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W 3RD ST
LA JUNTA CO
81050-1431
US

IV. Provider business mailing address

421 W 3RD ST
LA JUNTA CO
81050-1431
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-0450
  • Fax: 719-383-0454
Mailing address:
  • Phone: 719-383-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier52107027
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: IVA LOU BAILEY
Title or Position: OWNER
Credential:
Phone: 303-322-4100