MEDICARE: OUR HOUSE 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	385H00000X	Respite Care
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1932674306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HOUSE INC.

Provider Business Mailing Address
First Line	:	1609 S WAHSATCH AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2339
Country	:	US
Telephone Number	:	719-271-0676
Fax Number	:	719-477-0119

Provider Business Practice Location Address
First Line	:	4223 S MASON ST UNIT C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3048
Country	:	US
Telephone Number	:	970-459-0735
Fax Number	:	719-477-0119

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CAROL FISCHER
Credential	:
Telephone Number	:	719-477-0109

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/14/2021

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Directions to “OUR HOUSE INC. ” Practice Location

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