Provider Demographics
NPI:1508622929
Name:PIKES PEAK HOME CARE LLC
Entity Type:Organization
Organization Name:PIKES PEAK HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GURGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-226-0110
Mailing Address - Street 1:390 PRINTERS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3190
Mailing Address - Country:US
Mailing Address - Phone:720-226-0110
Mailing Address - Fax:720-226-0398
Practice Address - Street 1:390 PRINTERS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3190
Practice Address - Country:US
Practice Address - Phone:720-226-0110
Practice Address - Fax:720-226-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care