Provider Demographics
NPI:1427569409
Name:HOME CARE LLC
Entity Type:Organization
Organization Name:HOME CARE LLC
Other - Org Name:HOME CARE AT MOMA'S ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-330-6882
Mailing Address - Street 1:PO BOX 88393
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-8393
Mailing Address - Country:US
Mailing Address - Phone:719-330-6882
Mailing Address - Fax:719-494-0349
Practice Address - Street 1:2501 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1209
Practice Address - Country:US
Practice Address - Phone:719-330-6882
Practice Address - Fax:719-494-0349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23N521310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility