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General NPI Number Information
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NPI Number | 1881667376
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Entity Type | Organization
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Legal Business Name | PRIMARY HOME CARE
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 513 BROADWAY AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2115
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Country | US
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Telephone | 719-542-7141
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Fax | 719-543-5644
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Provider Business Mailing Address
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Address Line | 513 BROADWAY AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2115
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Country | US
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Telephone | 719-542-7141
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Fax | 719-543-5644
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JEWEL MARIE DENSFORD
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Credential | R.N.
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Telephone | 719-542-7141
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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 |
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License Number State | CO
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