Provider Demographics
NPI:1629258397
Name:MARYTIMES SERVICES, INC
Entity Type:Organization
Organization Name:MARYTIMES SERVICES, INC
Other - Org Name:SPECTRUM HOME SERVICES OF LARIMER COUNTY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-669-2627
Mailing Address - Street 1:3085 KIOWA DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8642
Mailing Address - Country:US
Mailing Address - Phone:970-669-2627
Mailing Address - Fax:323-313-0970
Practice Address - Street 1:3085 KIOWA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8642
Practice Address - Country:US
Practice Address - Phone:970-669-2627
Practice Address - Fax:323-313-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80488714251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13563OtherTRADING PARTNER ID
CO80488714Medicare PIN