Provider Demographics
NPI:1114630852
Name:COLUMBINE POUDRE HOME CARE, LLC
Entity Type:Organization
Organization Name:COLUMBINE POUDRE HOME CARE, LLC
Other - Org Name:BLOOM AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-482-0198
Mailing Address - Street 1:802 W DRAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5567
Mailing Address - Country:US
Mailing Address - Phone:970-482-0198
Mailing Address - Fax:
Practice Address - Street 1:915 CENTRE AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6046
Practice Address - Country:US
Practice Address - Phone:970-482-5096
Practice Address - Fax:970-224-2518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBINE POUDRE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty