Provider Demographics
NPI:1598943342
Name:ARK-VALLEY HOME & HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ARK-VALLEY HOME & HEALTH CARE SERVICES, LLC
Other - Org Name:ARK VALLEY HOME CARE - LA JUNTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVA LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-322-4100
Mailing Address - Street 1:421 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1431
Mailing Address - Country:US
Mailing Address - Phone:719-383-0450
Mailing Address - Fax:
Practice Address - Street 1:421 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1431
Practice Address - Country:US
Practice Address - Phone:719-383-0450
Practice Address - Fax:719-383-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52107027Medicaid