Provider Demographics
NPI:1003480286
Name:VAIL VALLEY IN-HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:VAIL VALLEY IN-HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:857-272-2801
Mailing Address - Street 1:1000 HOMESTEAD DR UNIT 25
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8209
Mailing Address - Country:US
Mailing Address - Phone:857-272-2801
Mailing Address - Fax:
Practice Address - Street 1:301 W. MAIN STREET, SUITE 205
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:857-272-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care