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General NPI Number Information
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NPI Number | 1396152641
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Entity Type | Organization
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Legal Business Name | COLORADO PLAINS HOME HEALTH LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 109 W LEE ST., #15
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City | LAMAR
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State | CO
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Zip | 81052
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Country | US
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Telephone | 719-336-1316
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Fax | 719-336-1318
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Provider Business Mailing Address
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Address Line | 109 W LEE ST., #15
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City | LAMAR
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State | CO
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Zip | 81052
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Country | US
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Telephone | 719-336-1316
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Fax | 719-336-1318
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Authorized Official
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Title or Position | CEO
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Name | MARTIN J MASAR
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Credential | LCSW
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Telephone | 719-336-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 04M124
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License Number State | CO
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