Provider Demographics
NPI:1609488824
Name:VIDACARE LLC
Entity Type:Organization
Organization Name:VIDACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-521-0617
Mailing Address - Street 1:11990 GRANT ST STE 550
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1101
Mailing Address - Country:US
Mailing Address - Phone:303-521-0617
Mailing Address - Fax:
Practice Address - Street 1:11990 GRANT ST STE 550
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1101
Practice Address - Country:US
Practice Address - Phone:303-521-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care