MEDICARE: HOME CARE OF GRAND JUNCTION 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	253Z00000X	In Home Supportive Care Agency	04X818	CO
2	253Z00000X	In Home Supportive Care Agency	10H563	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	:	1215315577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE OF GRAND JUNCTION LLC

Provider Business Mailing Address
First Line	:	2764 COMPASS DR., SUITE 105
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8755
Country	:	US
Telephone Number	:	970-245-7481
Fax Number	:	970-245-7481

Provider Business Practice Location Address
First Line	:	2764 COMPASS DR., SUITE 105
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8755
Country	:	US
Telephone Number	:	970-245-7481
Fax Number	:	970-245-7481

Authorized Official
Title or Position	:	CEO
Name	:	MS. STACIE BRATCHER
Credential	:
Telephone Number	:	817-349-9050

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	04/22/2021

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