Provider Demographics
NPI:1972664225
Name:1 HOME CARE AGENCY CORPORATION
Entity Type:Organization
Organization Name:1 HOME CARE AGENCY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAYNSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-306-0404
Mailing Address - Street 1:10200 E GIRARD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5500
Mailing Address - Country:US
Mailing Address - Phone:303-306-0404
Mailing Address - Fax:
Practice Address - Street 1:10200 E GIRARD AVE STE 105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5500
Practice Address - Country:US
Practice Address - Phone:303-306-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43026508Medicaid
CO9000160593Medicaid