Stillwater Home Care Agency, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

STILLWATER HOME CARE AGENCY, LLC

Practice address

10660 E Bethany Dr
Aurora, CO 80014-2602

Phone

(303) 753-7577

Fax

(719) 466-6172

NPI assigned

Aug 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Irina Gavrilov

Title

Administrator

Phone

(720) 298-9080

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Home health agency certification: CCN 067510

Legal name

STILLWATER HOME CARE AGENCY, LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jun 4, 2013

Last certification

May 8, 2019

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Aug 10, 2012 in CO

Enrollment address

10660E Bethany Dr
Aurora, CO 80014-2602

Listed as

Stillwater Home Care Agency LLCCCN 067510

Ownership

Proprietary

Certified

Jun 4, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1104173939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 E BETHANY DR",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142602",
            "telephone_number": "303-753-7577",
            "fax_number": "719-466-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10660 E BETHANY DR",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142602",
            "telephone_number": "303-753-7577",
            "fax_number": "719-466-6172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER HOME CARE AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-10",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "GAVRILOV",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "720-298-9080"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17326265",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sheila O'Grady Stille, D.M.D.
• Chelsey Stillman, PA-C
• Stillwater Ihss Limited
• Paul Stillwell, MD
• Terrence Daniel Stilson
• Amy Stimmler, PNP
• Makenzie Ann Stine, PT, DPT

• Home Health Agency in Aurora, CO
• Providers in Aurora, CO by specialty
• Home Health Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.