Provider Demographics
NPI:1417093659
Name:CENTURA HOME CARE LLC
Entity Type:Organization
Organization Name:CENTURA HOME CARE LLC
Other - Org Name:CENTURA LABORATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP FINANCE-CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-804-8189
Mailing Address - Street 1:DEPT 1908
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1908
Mailing Address - Country:US
Mailing Address - Phone:303-804-8112
Mailing Address - Fax:
Practice Address - Street 1:188 INVERNESS DR W STE 500
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5204
Practice Address - Country:US
Practice Address - Phone:303-804-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D0512503291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807967Medicare PIN