Provider Demographics
NPI:1942669692
Name:ENVISION HOSPICE OF COLORADO LLC
Entity type:Organization
Organization Name:ENVISION HOSPICE OF COLORADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIR. OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA, CHC
Authorized Official - Phone:303-500-5055
Mailing Address - Street 1:1720 S BELLAIRE ST STE 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4320
Mailing Address - Country:US
Mailing Address - Phone:303-500-5055
Mailing Address - Fax:866-610-0503
Practice Address - Street 1:1720 S BELLAIRE ST STE 308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4304
Practice Address - Country:US
Practice Address - Phone:720-900-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000154239Medicaid