Provider Demographics
NPI:1417261520
Name:QUEEN'S CARE IN HOME INC.
Entity Type:Organization
Organization Name:QUEEN'S CARE IN HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-371-6588
Mailing Address - Street 1:5054 BILLINGS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4323
Mailing Address - Country:US
Mailing Address - Phone:303-371-6588
Mailing Address - Fax:303-371-6637
Practice Address - Street 1:5054 BILLINGS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-4323
Practice Address - Country:US
Practice Address - Phone:303-371-6588
Practice Address - Fax:303-371-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04E902251E00000X
CO04F397253Z00000X
COB-10054343900000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66601380Medicaid