Provider Demographics
NPI:1073972097
Name:R&A HOME CARE
Entity Type:Organization
Organization Name:R&A HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEVOSYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-960-4732
Mailing Address - Street 1:7255 S HAVANA ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3887
Mailing Address - Country:US
Mailing Address - Phone:303-960-4732
Mailing Address - Fax:303-736-2195
Practice Address - Street 1:7255 S HAVANA ST STE 130
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3887
Practice Address - Country:US
Practice Address - Phone:303-960-4732
Practice Address - Fax:303-736-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04R666251E00000X
CO04R586253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48808016Medicaid
CO66681871Medicaid