Organization
ESSENTIAL EMBODIMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINS MARIE SWOFFER (OWNER)
(970) 778-9663
Entity
Organization
Contact information
Practice address
120 W MAIN ST, SUITE D, CEDAREDGE, CO 81413
(970) 808-1122
Mailing address
120 W MAIN ST, SUITE D, CEDAREDGE, CO 81413
(970) 808-1122
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
12181974
CO
253Z00000X
In Home Supportive Care Agency
Primary
4272017
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4272017
—
CO
Enumeration date
05/03/2017
Last updated
05/03/2017
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