Provider Demographics
NPI:1902461478
Name:PATRIOT HOME CARE GROUP LTD
Entity Type:Organization
Organization Name:PATRIOT HOME CARE GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGERSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-568-9880
Mailing Address - Street 1:1436 S BUCHANAN CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-6006
Mailing Address - Country:US
Mailing Address - Phone:720-568-9880
Mailing Address - Fax:
Practice Address - Street 1:1450 S HAVANA ST STE 306
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4023
Practice Address - Country:US
Practice Address - Phone:720-568-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No253Z00000XAgenciesIn Home Supportive Care