Provider Demographics
NPI:1881667376
Name:PRIMARY HOME CARE
Entity Type:Organization
Organization Name:PRIMARY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DENSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-542-7141
Mailing Address - Street 1:513 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2115
Mailing Address - Country:US
Mailing Address - Phone:719-542-7141
Mailing Address - Fax:719-543-5644
Practice Address - Street 1:513 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2115
Practice Address - Country:US
Practice Address - Phone:719-542-7141
Practice Address - Fax:719-543-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health