Healthcare Provider Details

I. General information

NPI: 1629682661
Provider Name (Legal Business Name): 303 HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14966 MELCO AVE
PARKER CO
80134-4437
US

IV. Provider business mailing address

14966 MELCO AVE
PARKER CO
80134-4437
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-7676
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name: ADA GURZHIEV
Title or Position: OWNER
Credential:
Phone: 303-805-7676