Provider Demographics
NPI:1245348010
Name:INDEPENDENCE AT HOME, INC.
Entity type:Organization
Organization Name:INDEPENDENCE AT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-421-2648
Mailing Address - Street 1:1340 CARR ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-6100
Mailing Address - Country:US
Mailing Address - Phone:303-421-2648
Mailing Address - Fax:303-233-1977
Practice Address - Street 1:1340 CARR ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-6100
Practice Address - Country:US
Practice Address - Phone:303-421-2648
Practice Address - Fax:303-233-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14502747Medicaid