=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528069523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT CARE HOME HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 09/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19751 EAST MAINSTREET SUITE 333
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-399-7797
-----------------------------------------------------
Fax | 303-399-7793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19751 EAST MAINSTREET SUITE 333
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-399-7797
-----------------------------------------------------
Fax | 303-399-7793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. DAWN MARIE VILLALVA
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 303-399-7797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | 0404F5
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0404F5
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------