=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972907095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLECARE OF NORTHERN COLORADO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2014
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E 7TH ST STE 416
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80537-4871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-480-0529
-----------------------------------------------------
Fax | 970-775-5811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12015 E 46TH AVE STE 650
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80239-3158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-863-1477
-----------------------------------------------------
Fax | 720-780-1390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-CEO
-----------------------------------------------------
Name | LORIN CHEVALIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-863-1477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 00000
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 00000
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------