Healthcare Provider Details

I. General information

NPI: 1891762316
Provider Name (Legal Business Name): INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MAIN ST SUITE 400
PUEBLO CO
81003-3020
US

IV. Provider business mailing address

720 N MAIN ST SUITE 400
PUEBLO CO
81003-3020
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-1184
  • Fax: 719-545-1746
Mailing address:
  • Phone: 719-545-1184
  • Fax: 719-545-1746

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 Number040680
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA RINGLING
Title or Position: CCO
Credential: RN
Phone: 719-632-9900