Provider Demographics
NPI:1821039256
Name:PREFERRED HOMECARE OF COLOARDO, LLC
Entity type:Organization
Organization Name:PREFERRED HOMECARE OF COLOARDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVT COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:480-446-9010
Mailing Address - Fax:480-993-2033
Practice Address - Street 1:689 COUNTY ROAD 233
Practice Address - Street 2:STE. A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6561
Practice Address - Country:US
Practice Address - Phone:970-259-3975
Practice Address - Fax:970-259-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25570030Medicaid
CO25570030Medicaid