Provider Demographics
NPI:1083237838
Name:COLORADO DOMESTIC CARE INC.
Entity Type:Organization
Organization Name:COLORADO DOMESTIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:BELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-299-5995
Mailing Address - Street 1:125 N PARKSIDE DR SUITE 201 -I
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6097
Mailing Address - Country:US
Mailing Address - Phone:719-800-2232
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR SUITE 201-I
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-8090
Practice Address - Country:US
Practice Address - Phone:719-800-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20191748380Medicaid