Provider Demographics
NPI:1083063317
Name:SOLACE HOME HEALTHCARE
Entity Type:Organization
Organization Name:SOLACE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST-CF
Authorized Official - Prefix:MISS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-530-4191
Mailing Address - Street 1:495 UINTA WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7198
Mailing Address - Country:US
Mailing Address - Phone:303-432-8487
Mailing Address - Fax:
Practice Address - Street 1:495 UINTA WAY STE 140
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7198
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63054051Medicaid