Healthcare Provider Details

I. General information

NPI: 1972942654
Provider Name (Legal Business Name): COMMUNI-CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S UNION AVE # A
PUEBLO CO
81003-3490
US

IV. Provider business mailing address

221 S UNION AVE
PUEBLO CO
81003-3490
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-1114
  • Fax: 719-546-6154
Mailing address:
  • Phone: 719-545-1114
  • Fax: 719-546-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberO4N228
License Number StateCO

VIII. Authorized Official

Name: MR. BARBARA J.H. YAEGER
Title or Position: OWNER
Credential:
Phone: 719-545-1114