Provider Demographics
NPI:1659858447
Name:ENVISION HOSPICE OF COLORADO LLC
Entity type:Organization
Organization Name:ENVISION HOSPICE OF COLORADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIR. OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA, CHC
Authorized Official - Phone:303-500-5055
Mailing Address - Street 1:1720 S BELLAIRE ST STE 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4320
Mailing Address - Country:US
Mailing Address - Phone:303-500-5055
Mailing Address - Fax:866-610-0503
Practice Address - Street 1:7150 CAMPUS DR STE 330
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3180
Practice Address - Country:US
Practice Address - Phone:719-596-5001
Practice Address - Fax:719-596-5003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION HOSPICE OF COLORADO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-24
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17C439251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based