Provider Demographics
NPI:1457802522
Name:5280 HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:5280 HOME HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-300-4455
Mailing Address - Street 1:6208 LEHMAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8404
Mailing Address - Country:US
Mailing Address - Phone:719-300-4455
Mailing Address - Fax:719-300-4466
Practice Address - Street 1:6208 LEHMAN DR STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8404
Practice Address - Country:US
Practice Address - Phone:719-300-4455
Practice Address - Fax:719-300-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04Z790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
067563OtherMEDICARE
CO9000157103Medicaid