MEDICARE: HOME 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	310400000X	Assisted Living Facility	23U759	CO

General Provider Information

NPI Number	:	1518478593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 88393
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-8393
Country	:	US
Telephone Number	:	719-330-6882
Fax Number	:	719-494-0349

Provider Business Practice Location Address
First Line	:	1929 MEYERS AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2149
Country	:	US
Telephone Number	:	719-330-6882
Fax Number	:	719-494-0349

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH LEE
Credential	:
Telephone Number	:	719-330-6882

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	10/18/2017

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