Provider Demographics
NPI:1861536690
Name:EASTERN COLORADO HOME CARE LLC.
Entity type:Organization
Organization Name:EASTERN COLORADO HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-522-3911
Mailing Address - Street 1:352 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-2311
Mailing Address - Country:US
Mailing Address - Phone:970-522-3911
Mailing Address - Fax:970-522-5131
Practice Address - Street 1:352 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2311
Practice Address - Country:US
Practice Address - Phone:970-522-3911
Practice Address - Fax:970-522-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43139329Medicaid