MEDICARE: COLUMBINE POUDRE HOME CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant
3	374U00000X	Home Health Aide
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114630852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBINE POUDRE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-482-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 CENTRE AVE STE 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6046
Country	:	US
Telephone Number	:	970-482-5096
Fax Number	:	970-224-2518

Authorized Official
Title or Position	:	CFO
Name	:	BARRY K FANCHER
Credential	:
Telephone Number	:	970-482-0198

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

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