Provider Demographics
NPI:1255308771
Name:INTERIM HEALTHCARE OF GREATER DENVER INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF GREATER DENVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-789-4686
Mailing Address - Street 1:333 W HAMPDEN AVE STE 925
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2477
Mailing Address - Country:US
Mailing Address - Phone:303-789-4686
Mailing Address - Fax:303-789-1644
Practice Address - Street 1:333 W HAMPDEN AVE STE 925
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2477
Practice Address - Country:US
Practice Address - Phone:303-789-4686
Practice Address - Fax:303-789-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04T695OtherSTATE OF COLORADO HOME CARE AGENCY MEDICAL CLASS A LICENSE
CO85480240Medicaid
CO067438Medicare ID - Type Unspecified