Provider Demographics
NPI:1194832196
Name:NORTHEAST PLAINS HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:NORTHEAST PLAINS HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:970-522-3045
Mailing Address - Street 1:P.O. BOX 789
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751
Mailing Address - Country:US
Mailing Address - Phone:970-522-3045
Mailing Address - Fax:970-522-3047
Practice Address - Street 1:731 W. MAIN
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751
Practice Address - Country:US
Practice Address - Phone:970-522-3045
Practice Address - Fax:970-522-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25478028Medicaid
CO067460Medicare Oscar/Certification