Provider Demographics
NPI:1447227962
Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO INC.
Other - Org Name:INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RINGLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-632-9900
Mailing Address - Street 1:1901 N UNION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2283
Mailing Address - Country:US
Mailing Address - Phone:719-632-9900
Mailing Address - Fax:719-632-2470
Practice Address - Street 1:1901 N UNION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2283
Practice Address - Country:US
Practice Address - Phone:719-632-9900
Practice Address - Fax:719-632-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CO040510253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000130908Medicaid
CO05017215Medicaid