Provider Demographics
NPI:1184219396
Name:ASPEN VALLEY HOME HEALTH LLC
Entity Type:Organization
Organization Name:ASPEN VALLEY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-235-7559
Mailing Address - Street 1:133 PROSPECTOR RD STE 4102T
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-3389
Mailing Address - Country:US
Mailing Address - Phone:631-235-7559
Mailing Address - Fax:
Practice Address - Street 1:133 PROSPECTOR RD STE 4102T
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3389
Practice Address - Country:US
Practice Address - Phone:631-235-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health