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General NPI Number Information
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NPI Number | 1780724559
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Entity Type | Organization
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Legal Business Name | CENTENNIAL HOME CARE, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 600 RUSSELL ST
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City | CRAIG
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State | CO
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Zip | 81625-2018
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Country | US
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Telephone | 970-824-6882
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Fax | 970-824-2157
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Provider Business Mailing Address
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Address Line | 600 RUSSELL ST
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City | CRAIG
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State | CO
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Zip | 81625-2018
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Country | US
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Telephone | 970-824-6882
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Fax | 970-824-2157
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Authorized Official
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Title or Position | DIRECTOR
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Name | KRISTINE COOPER
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Credential |
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Telephone | 970-826-2421
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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 | 06D1019559
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License Number State | CO
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