Provider Demographics
NPI:1205344280
Name:STILLWATER IHSS LIMITED
Entity type:Organization
Organization Name:STILLWATER IHSS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-298-9080
Mailing Address - Street 1:10660 E BETHANY DR OFC 26
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2602
Mailing Address - Country:US
Mailing Address - Phone:303-753-7577
Mailing Address - Fax:719-466-6172
Practice Address - Street 1:10660 E BETHANY DR OFC 26
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2602
Practice Address - Country:US
Practice Address - Phone:303-753-7577
Practice Address - Fax:719-466-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17326265Medicaid