Provider Demographics
NPI:1316556004
Name:COWBOY HOME CARE
Entity Type:Organization
Organization Name:COWBOY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-449-0854
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0896
Mailing Address - Country:US
Mailing Address - Phone:970-449-0854
Mailing Address - Fax:
Practice Address - Street 1:8895 INDIAN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1792
Practice Address - Country:US
Practice Address - Phone:970-449-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care