Provider Demographics
NPI:1083789341
Name:KAISER FOUNDATION HEALTHPLAN OF COLORADO
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTHPLAN OF COLORADO
Other - Org Name:KAISER PERMANENTE HOME IV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENESE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-326-6717
Mailing Address - Street 1:16601 E CENTRETECH PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9045
Mailing Address - Country:US
Mailing Address - Phone:303-344-7010
Mailing Address - Fax:303-344-7048
Practice Address - Street 1:16601 E CENTRETECH PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9045
Practice Address - Country:US
Practice Address - Phone:303-344-7010
Practice Address - Fax:303-344-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336M0003X
COPDO700000023336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003191OtherPK