Provider Demographics
NPI:1043618416
Name:COLORADO FAMILY QUALITY HOME CARE
Entity Type:Organization
Organization Name:COLORADO FAMILY QUALITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:303-632-7225
Mailing Address - Street 1:1450 S HAVANA ST STE 410
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4025
Mailing Address - Country:US
Mailing Address - Phone:720-296-4293
Mailing Address - Fax:303-632-7225
Practice Address - Street 1:1450 S HAVANA ST
Practice Address - Street 2:SUITE410
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4018
Practice Address - Country:US
Practice Address - Phone:720-296-4293
Practice Address - Fax:303-632-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04J169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39262006Medicaid
CO04J169OtherMEDICARE
CO04U759Medicaid