Provider Demographics
NPI:1740711373
Name:REDEEMER ULTIMATE CARE SERVICES LLC
Entity type:Organization
Organization Name:REDEEMER ULTIMATE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:FONTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASONGANYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-486-4915
Mailing Address - Street 1:2030 MANNING WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4833
Mailing Address - Country:US
Mailing Address - Phone:404-602-2149
Mailing Address - Fax:
Practice Address - Street 1:2030 MANNING WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4833
Practice Address - Country:US
Practice Address - Phone:404-602-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health