Provider Demographics
NPI:1992396626
Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RINGLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-632-9900
Mailing Address - Street 1:720 N. MAIN ST.
Mailing Address - Street 2:STE. 400
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3048
Mailing Address - Country:US
Mailing Address - Phone:719-202-0036
Mailing Address - Fax:719-202-4304
Practice Address - Street 1:720 N. MAIN ST.
Practice Address - Street 2:STE. 400
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3048
Practice Address - Country:US
Practice Address - Phone:719-202-0036
Practice Address - Fax:719-202-4304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF SOUTHEASTERN COLORADO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-26
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09106235Medicaid