MEDICARE: PREFERRED HOMECARE OF COLORADO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336M0002X	Mail Order Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
4	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972505113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED HOMECARE OF COLORADO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 40700
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85274-0700
Country	:	US
Telephone Number	:	480-446-9010
Fax Number	:	480-993-2033

Provider Business Practice Location Address
First Line	:	6900 W JEFFERSON AVE
Second Line	:	STE 125
City	:	LAKEWOOD
State	:	CO
Zip	:	80235-2002
Country	:	US
Telephone Number	:	303-783-1700
Fax Number	:	303-788-0123

Authorized Official
Title or Position	:	GOVERNMENT COMPLIANCE MANAGER
Name	:	TERI L JAMISON
Credential	:
Telephone Number	:	480-446-9010

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/04/2008

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Directions to “PREFERRED HOMECARE OF COLORADO, LLC ” Practice Location

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