MEDICARE: GLIMMER OF HOPE HOME HEALTH CARE LLP

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	376J00000X	Homemaker
2	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04R530	OTHER	CO	BUSINESS LICENSE

General Provider Information

NPI Number	:	1770133829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLIMMER OF HOPE HOME HEALTH CARE LLP

Provider Business Mailing Address
First Line	:	6842 MESCALERO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3110
Country	:	US
Telephone Number	:	719-331-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	6842 MESCALERO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3110
Country	:	US
Telephone Number	:	719-331-2610
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. THERESA LYNN RUSSELL
Credential	:
Telephone Number	:	719-331-2610

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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