Basic Information
| Provider Information | |||||||||
| NPI: | 1477556934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRU COMMUNITY CARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICE OF BOULDER COUNTY | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2594 TRAILRIDGE DRIVE EAST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034497740 | ||||||||
| FaxNumber: | 3036045393 | ||||||||
| Practice Location | |||||||||
| Address1: | 2594 TRAILRIDGE DRIVE EAST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034497740 | ||||||||
| FaxNumber: | 3036045393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCHALE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 3036045244 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 170324 | CO | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 315D00000X | 17R718 | CO | N | Nursing & Custodial Care Facilities | Hospice, Inpatient | 251G00000X | 0179 | CO | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 37888871 | 05 | CO | MEDICAID | 05800099 | 05 | CO | MEDICAID |