Provider Demographics
NPI:1972200459
Name:OPPO
Entity Type:Organization
Organization Name:OPPO
Other - Org Name:PRISTINE CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-637-9158
Mailing Address - Street 1:6000 E EVANS AVE STE 3-320
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5441
Mailing Address - Country:US
Mailing Address - Phone:720-230-3363
Mailing Address - Fax:
Practice Address - Street 1:2953 S PEORIA ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5716
Practice Address - Country:US
Practice Address - Phone:408-637-9158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04C869OtherCOLORADO HOME HEALTHCARE LICENSE