Provider Demographics
NPI:1871198952
Name:TEAMSELECT HOME CARE OF COLORADO, LLC
Entity Type:Organization
Organization Name:TEAMSELECT HOME CARE OF COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-288-4059
Mailing Address - Street 1:2999 N 44TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7247
Mailing Address - Country:US
Mailing Address - Phone:602-382-8500
Mailing Address - Fax:602-253-5656
Practice Address - Street 1:1407 FORTINO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-8100
Practice Address - Country:US
Practice Address - Phone:719-292-1231
Practice Address - Fax:719-292-1230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAMSELECT HOME CARE OF COLORADO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000160968Medicaid