Provider Demographics
NPI:1790119204
Name:CIMARRON HOME CARE, LLC
Entity type:Organization
Organization Name:CIMARRON HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-201-7297
Mailing Address - Street 1:2809 BUNTING AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6500
Mailing Address - Country:US
Mailing Address - Phone:970-249-6767
Mailing Address - Fax:970-249-4284
Practice Address - Street 1:300 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-249-6767
Practice Address - Fax:970-249-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04D513Medicaid