MEDICARE: CHARITY CARES HOME CARE AGENCY 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	385H00000X	Respite Care
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518586460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARITY CARES HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	2930 N ACADEMY BLVD STE 204
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5342
Country	:	US
Telephone Number	:	719-238-7802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 N ACADEMY BLVD STE 204
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5342
Country	:	US
Telephone Number	:	719-238-7802
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SERVICES
Name	:	LINDA JOHNSON
Credential	:
Telephone Number	:	719-238-7802

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	04/10/2020

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