Basic Information
| Provider Information | |||||||||
| NPI: | 1033676192 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AGE IN PLACE HOME HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11375 E VASSAR DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800141836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035484310 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 11375 E VASSAR DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800141836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035484310 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2019 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCWILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | CONSTANCE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 3035484310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251J00000X | N | Agencies | Nursing Care | 251S00000X | N | Agencies | Community/Behavioral Health | 253Z00000X | N | Agencies | In Home Supportive Care | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 123456 | 01 | INTERNAL USE | OTHER |