Provider Demographics
NPI:1013463868
Name:STATEWIDE HEALTHCARE LLC
Entity Type:Organization
Organization Name:STATEWIDE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANELECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEOMAMERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-434-1513
Mailing Address - Street 1:2130 S. ACADEMY BLVD
Mailing Address - Street 2:#103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916
Mailing Address - Country:US
Mailing Address - Phone:719-434-1513
Mailing Address - Fax:
Practice Address - Street 1:2130 S. ACADEMY BLVD.
Practice Address - Street 2:#103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916
Practice Address - Country:US
Practice Address - Phone:719-434-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO041455253Z00000X
376J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty