Provider Demographics
NPI:1760140628
Name:MDM HOMECARE LLC
Entity Type:Organization
Organization Name:MDM HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVANIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-822-1229
Mailing Address - Street 1:13395 VOYAGER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7678
Mailing Address - Country:US
Mailing Address - Phone:719-822-1229
Mailing Address - Fax:719-822-1787
Practice Address - Street 1:13395 VOYAGER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7678
Practice Address - Country:US
Practice Address - Phone:719-822-1229
Practice Address - Fax:719-822-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care