MEDICARE: 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	310400000X	Assisted Living Facility	23M206	CO

General Provider Information

NPI Number	:	1972938355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 88393
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-8393
Country	:	US
Telephone Number	:	719-330-6882
Fax Number	:	719-494-0349

Provider Business Practice Location Address
First Line	:	9340 BURGESS RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4161
Country	:	US
Telephone Number	:	719-330-6882
Fax Number	:	719-494-0349

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH F LEE
Credential	:
Telephone Number	:	719-330-6882

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	09/05/2013

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