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General NPI Number Information
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NPI Number | 1063233229
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Entity Type | Organization
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Legal Business Name | SOUTHPORT HEALTHCARE INC.
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1001 BANNOCK ST UNIT 227
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City | DENVER
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State | CO
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Zip | 80204-4145
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Country | US
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Telephone | 720-902-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 BANNOCK ST UNIT 227
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City | DENVER
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State | CO
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Zip | 80204-4145
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Country | US
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Telephone | 720-902-7069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH ODWYER
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Credential | RN
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Telephone | 303-503-3616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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