Organization
SAND AND SAGE PERSONAL CARE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE RAE HINER (OWNER/MANAGER)
(719) 688-9666
Entity
Organization
Contact information
Practice address
121 W BEECH ST, LAMAR, CO 81052-2731
(719) 688-9666
(719) 691-2132
Mailing address
117 WEST ELM STREET, LAMAR, CO 81052
(719) 688-9666
(719) 691-2132
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
04S685
CO
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30854369
—
CO
Enumeration date
10/07/2015
Last updated
11/05/2021
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