Healthcare Provider Details

I. General information

NPI: 1104414747
Provider Name (Legal Business Name): PHHC ACQUISITION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 FORTINO BLVD STE A
PUEBLO CO
81008-1982
US

IV. Provider business mailing address

6330 SPRINT PKWY STE 300
OVERLAND PARK KS
66211-1157
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-0832
  • Fax: 719-583-0849
Mailing address:
  • Phone:
  • Fax: 913-814-4843

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: JOHN NICHOLS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 719-583-0832