Provider Demographics
NPI:1548765696
Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC
Other - Org Name:INTERIM HEALTHCARE PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
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 STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-7200
Mailing Address - Country:US
Mailing Address - Phone:719-314-4868
Mailing Address - Fax:
Practice Address - Street 1:1901 N UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-7200
Practice Address - Country:US
Practice Address - Phone:719-314-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36458207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20180727Medicaid