{
"Npi": {
"NPI": "1790119204",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CIMARRON HOME CARE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2809 BUNTING AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND JUNCTION",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81501-6500",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-249-6767",
"MailingAddressFaxNumber": "970-249-4284",
"FirstLinePracticeLocationAddress": "300 MAIN ST STE 306",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND JUNCTION",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81501-2404",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-249-6767",
"PracticeLocationAddressFaxNumber": "970-249-4284",
"EnumerationDate": "09/03/2013",
"LastUpdateDate": "01/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIAUQUE",
"AuthorizedOfficialFirstName": "JOE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "970-201-7297",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}