Provider Demographics
NPI:1770998544
Name:DOMINICAN HOME HEALTH AGENCY, INC.
Entity type:Organization
Organization Name:DOMINICAN HOME HEALTH AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTING
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN,MBA
Authorized Official - Phone:3030-322-1413
Mailing Address - Street 1:2501 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5631
Mailing Address - Country:US
Mailing Address - Phone:303-322-1413
Mailing Address - Fax:303-322-2702
Practice Address - Street 1:2501 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5631
Practice Address - Country:US
Practice Address - Phone:303-322-1413
Practice Address - Fax:303-322-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04F925251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health