Provider Demographics
NPI:1982170114
Name:A PHYSICIANS HOME CARE
Entity Type:Organization
Organization Name:A PHYSICIANS HOME CARE
Other - Org Name:A PHYSICIANS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-434-2585
Mailing Address - Street 1:905 W GARDEN OF THE GODS RD SUITE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-434-2585
Mailing Address - Fax:719-434-1791
Practice Address - Street 1:905 W GARDEN OF THE GODS RD SUITE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-434-2585
Practice Address - Fax:719-434-1791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PHYSICIANS HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153168Medicaid