Provider Demographics
NPI:1003024514
Name:COLORADO SPIRIT HOME CARE
Entity Type:Organization
Organization Name:COLORADO SPIRIT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DILRABO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASIMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-695-8888
Mailing Address - Street 1:10700 E BETHANY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-695-8888
Mailing Address - Fax:303-695-8881
Practice Address - Street 1:10700 E BETHANY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-695-8888
Practice Address - Fax:303-695-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10G509253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64100855Medicaid