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Organization Active NPI

Columbine Poudre Home Care, LLC

  • Home Health Agency
  • Fort Collins, CO
National Provider Identifier
1184623977
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
COLUMBINE POUDRE HOME CARE, LLC
Practice address
915 Centre Ave
Suite 2
Fort Collins, CO 80526-6045
Phone
(970) 482-5096
Fax
(970) 224-2518
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

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

Authorized official

Name
Mr. J. Robert Wilson
Title
Owner
Phone
(970) 482-0198

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X

Addresses

Primary practice location

915 Centre Ave
Suite 2
Fort Collins, CO 80526-6045

Mailing address

915 Centre Ave
Suite 2
Fort Collins, CO 80526-6045
Phone (970) 482-5096

Other identifiers 3

IdentifierTypeStateIssuer
638551OtherBCBS PROVIDER #
36373036MedicaidCO
29286573MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000184 CO Part A Provider - Home Health Agency 8123911401 Practice locations: Fort Collins, CO

Home health agency certification: CCN 067084A

Legal name
COLUMBINE POUDRE HOME CARE, LLC
Organization structure
LLCProprietary
Incorporated
Jan 25, 2000 in CO
Enrollment address
915 Centre Ave
Ste 2
Fort Collins, CO 80526-6046

National Provider Directory

National Provider Directory
Tax ID family
Columbine Poudre Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

915 Centre Ave
Ste 2
Fort Collins, CO 80526
Phone (970) 482-5096

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Lakota Lake LLC Organization, Fort Collins, CO LLC 5% Or Greater Direct Ownership Interest Jan 25, 2000 50%
John Robert Wilson Individual 5% Or Greater Direct Ownership InterestManagerial/Consultative Jan 24, 2000 50%
Corporate OfficerOwner/Board Member Jan 24, 2000 100%
Corporate DirectorOwner/Board Member Jan 24, 2000 100%
Holly Lynn Johnson Individual W-2 Managing EmployeeDirector Nov 1, 2021 100%
Lauren J Fasciano-Sager Individual Corporate OfficerSecretary Nov 21, 2012 100%
Operational/Managerial ControlSecretary Nov 21, 2012
Barry Kent Fancher Individual Corporate OfficerTreasurer Jan 24, 2000 100%
Operational/Managerial ControlCoo & Cfo Jan 24, 2000 100%
Columbine Management Services Inc Organization, Fort Collins, CO Corporation Operational/Managerial Control Jan 25, 2000 100%

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762905600000",
    "number": "1184623977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 CENTRE AVE",
            "address_2": "SUITE 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266045",
            "telephone_number": "970-482-5096",
            "fax_number": "970-224-2518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 CENTRE AVE",
            "address_2": "SUITE 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266045",
            "telephone_number": "970-482-5096",
            "fax_number": "970-224-2518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBINE POUDRE HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-482-0198",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "638551",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36373036",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29286573",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.