MEDICARE: DOMINICAN HOME HEALTH AGENCY, INC.

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	251E00000X	Home Health Agency	04F925	CO

General Provider Information

NPI Number	:	1770998544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINICAN HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	2501 GAYLORD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5631
Country	:	US
Telephone Number	:	303-322-1413
Fax Number	:	303-322-2702

Provider Business Practice Location Address
First Line	:	2501 GAYLORD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5631
Country	:	US
Telephone Number	:	303-322-1413
Fax Number	:	303-322-2702

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KRISANDRA PANTING
Credential	:	BSN,RN,MBA
Telephone Number	:	30303221413

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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