MEDICARE: 5280 HOME HEALTH CARE 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	04Z790	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	067563	OTHER		MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1457802522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5280 HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	6208 LEHMAN DR STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8404
Country	:	US
Telephone Number	:	719-300-4455
Fax Number	:	719-300-4466

Provider Business Practice Location Address
First Line	:	6208 LEHMAN DR STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8404
Country	:	US
Telephone Number	:	719-300-4455
Fax Number	:	719-300-4466

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YEVGENIY MAGAY
Credential	:
Telephone Number	:	719-300-4455

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	11/12/2021

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