=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790300853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 5 STAR HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2020
-----------------------------------------------------
Last Update Date | 06/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1966 W 15TH ST STE 3
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-3565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-685-4836
-----------------------------------------------------
Fax | 970-966-7847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1966 W 15TH ST STE 3
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-3565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-685-4836
-----------------------------------------------------
Fax | 970-966-7847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ADMINISTRATOR
-----------------------------------------------------
Name | HEIDI MARIE JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-685-4836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------