Provider Demographics
NPI:1164824553
Name:PASCO-SW, INC
Entity Type:Organization
Organization Name:PASCO-SW, INC
Other - Org Name:PASCO/SW HOME HEATLH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-6833
Mailing Address - Street 1:2764 COMPASS DR STE 244
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8722
Mailing Address - Country:US
Mailing Address - Phone:970-208-1430
Mailing Address - Fax:970-564-8057
Practice Address - Street 1:2764 COMPASS DR STE 244
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8722
Practice Address - Country:US
Practice Address - Phone:970-208-1430
Practice Address - Fax:970-564-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66335035Medicaid