=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992215404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE SPRUCE HOME CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2017
-----------------------------------------------------
Last Update Date | 10/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6440 E COLFAX AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-333-0100
-----------------------------------------------------
Fax | 303-322-3200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6440 E COLFAX AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-333-0100
-----------------------------------------------------
Fax | 303-322-3200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RUSLAN LOSHAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-333-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 04N224
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------