Provider Demographics
NPI:1689123317
Name:KIND HEART HOME HEALTH CARE
Entity Type:Organization
Organization Name:KIND HEART HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-622-1708
Mailing Address - Street 1:6170 LEHMAN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3443
Mailing Address - Country:US
Mailing Address - Phone:719-210-8733
Mailing Address - Fax:719-597-5170
Practice Address - Street 1:6170 LEHMAN DR STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3443
Practice Address - Country:US
Practice Address - Phone:719-210-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04K999251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64403572Medicaid