MEDICARE: CENTER HOME HEALTH SERVICES INC

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	04O533	CO
2	253Z00000X	In Home Supportive Care Agency	04D457	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040533	OTHER	CO	COLORADO LICENSE
2	04D457	OTHER	CO	COLORADO LICENSE

General Provider Information

NPI Number	:	1487152393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	721 4TH ST STE A
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 4TH ST STE A
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1846
Country	:	US
Telephone Number	:	303-990-9026
Fax Number	:	303-990-9026

Authorized Official
Title or Position	:	VP
Name	:	CELENA KIM GARCIA
Credential	:
Telephone Number	:	303-990-9026

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	03/17/2018

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