=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306939970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERIM HEALTHCARE OF WESTERN COLORADO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 10/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2764 COMPASS DR STE 225
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-8735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-241-3166
-----------------------------------------------------
Fax | 970-241-2757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2764 COMPASS DR STE 225
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-8735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-241-3166
-----------------------------------------------------
Fax | 970-241-2757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY ADMINISTRATOR
-----------------------------------------------------
Name | MS. KATHERINE E KYLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-241-3166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------