MEDICARE: ELEMENT 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	253Z00000X	In Home Supportive Care Agency	04X825	CO

General Provider Information

NPI Number	:	1528576816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENT HOME CARE LLC

Provider Business Mailing Address
First Line	:	8145 CANDLEFLOWER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5753
Country	:	US
Telephone Number	:	719-900-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	8145 CANDLEFLOWER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5753
Country	:	US
Telephone Number	:	719-900-8820
Fax Number	:	855-275-5715

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA ROEPKEN
Credential	:
Telephone Number	:	719-900-8820

Provider Enumeration Date	:	01/20/2018
Last Update Date	:	01/20/2018

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