MEDICARE: THE COACH HOME CARE AND CONSULTING AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	04M594	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114386448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COACH HOME CARE AND CONSULTING AGENCY, LLC

Provider Business Mailing Address
First Line	:	1900 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5850
Country	:	US
Telephone Number	:	719-391-4444
Fax Number	:	719-390-6895

Provider Business Practice Location Address
First Line	:	1900 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5850
Country	:	US
Telephone Number	:	719-391-4444
Fax Number	:	719-390-6895

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHRISTEL AIME
Credential	:	RN-BSN
Telephone Number	:	719-231-2152

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/23/2022

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