Provider Demographics
NPI:1578000386
Name:WINDS OF CHANGE, IHC
Entity Type:Organization
Organization Name:WINDS OF CHANGE, IHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RESA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-243-1565
Mailing Address - Street 1:832 W PRENTICE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1454
Mailing Address - Country:US
Mailing Address - Phone:303-243-1565
Mailing Address - Fax:
Practice Address - Street 1:832 W PRENTICE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1454
Practice Address - Country:US
Practice Address - Phone:303-243-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMEDICAIDMedicaid