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General NPI Number Information
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NPI Number | 1588089015
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Entity Type | Organization
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Legal Business Name | IMMACULATE CARE OPTIMAL NURSING HOME & HEALTH LLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 2821 S. PARKER RD. SUITE 177
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City | AURORA
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State | CO
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Zip | 80014
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Country | US
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Telephone | 720-480-5086
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Fax | 720-535-7221
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Provider Business Mailing Address
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Address Line | 2821 S. PARKER RD SUITE 177
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City | AURORA
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State | CO
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Zip | 80014
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Country | US
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Telephone | 720-480-5086
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Fax | 720-535-7221
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Authorized Official
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Title or Position | CEO
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Name | MS. ALMA HISSONG
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Credential |
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Telephone | 720-480-5086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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