Provider Demographics
NPI:1619189727
Name:INDEPENDENT GROWTH HOME HEALTH
Entity Type:Organization
Organization Name:INDEPENDENT GROWTH HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-343-9800
Mailing Address - Street 1:14201 E. 4TH AVE.
Mailing Address - Street 2:BLDG. 4, SUITE 130
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:303-343-9800
Mailing Address - Fax:303-343-4800
Practice Address - Street 1:14201 E. 4TH AVE.
Practice Address - Street 2:BLDG. 4, SUITE 130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:303-343-9800
Practice Address - Fax:303-349-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16431022251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16431022Medicaid