Provider Demographics
NPI:1801115944
Name:MGA HOME HEALTHCARE COLORADO, LLC
Entity type:Organization
Organization Name:MGA HOME HEALTHCARE COLORADO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CRITCHFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:719-476-0200
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:602-508-1883
Mailing Address - Fax:602-385-4941
Practice Address - Street 1:1355 GARDEN OF THE GODS ROAD
Practice Address - Street 2:#130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-476-0200
Practice Address - Fax:719-476-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COO4U328251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19053380Medicaid