MEDICARE: MILE HIGH HOMECARE 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	04K101	CO
2	253Z00000X	In Home Supportive Care Agency	HCBS-04T617	CO

General Provider Information

NPI Number	:	1508307612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH HOMECARE LLC

Provider Business Mailing Address
First Line	:	7475 DAKIN ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-6967
Country	:	US
Telephone Number	:	720-429-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	7475 DAKIN ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-6967
Country	:	US
Telephone Number	:	720-429-5805
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EMILY C NEUHOLD
Credential	:	RN
Telephone Number	:	720-429-5805

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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Directions to “MILE HIGH HOMECARE LLC ” Practice Location

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