=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114422706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOCO HEALING HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2018
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 541 GARDEN DRIVE UNIT O, SUITE 100
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-397-5409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 LOCUST ST
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80550-5265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-397-5409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/DIRECTOR OF NURSING
-----------------------------------------------------
Name | MRS. LAURA ANN WINING
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 970-397-5409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------