Healthcare Provider Details

I. General information

NPI: 1447517826
Provider Name (Legal Business Name): LITTLE HOME HEALTH ON THE PRAIRIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 COLORADO ST
LIMON CO
80828-2213
US

IV. Provider business mailing address

PO BOX 1243
LIMON CO
80828-1243
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-8599
  • Fax: 719-775-8589
Mailing address:
  • Phone: 719-775-8599
  • Fax: 719-775-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberZ00790
License Number StateCO

VIII. Authorized Official

Name: MS. KIMBERLY ANN ROSLER
Title or Position: OWNER
Credential: RN
Phone: 719-775-8599