Provider Demographics
NPI:1437126950
Name:INTERIM HEALTHCARE OF FORT COLLINS, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF FORT COLLINS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-472-4180
Mailing Address - Street 1:2000 VERMONT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2900
Mailing Address - Country:US
Mailing Address - Phone:970-472-4180
Mailing Address - Fax:970-472-4183
Practice Address - Street 1:2000 VERMONT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2900
Practice Address - Country:US
Practice Address - Phone:970-472-4180
Practice Address - Fax:970-472-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CO1003YH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05701297Medicaid
CO0403FHOtherSTATE LICENSE CLASS A MEDICAL
CO1003YHOtherSTATE LICENSE CLASS B NON-MEDICAL
CO05701297Medicaid