=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114383379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1ST COMFORT HOME HEALTH, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2016
-----------------------------------------------------
Last Update Date | 01/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5116 S DELAWARE ST APT C106
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110-6750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-517-0418
-----------------------------------------------------
Fax | 303-200-8799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5116 S DELAWARE ST APT C106
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110-6750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 303-200-8799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | TANYA BRYNNE PRESTA
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 720-517-0418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 04B427
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------