Jacqueline Rae Hiner
Individual provider Active NPI In Home Supportive Care Agency · Lamar, CO
NPI 1740887405 · NPPES record last updated Apr 15, 2021
Key facts
- NPI
- 1740887405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- License
- 04S685 (CO)
- Practice address
- 117 W Elm St
Lamar, CO 81052-2701 - Phone
- (719) 691-1941
- Fax
- (719) 691-2132
- NPI assigned
- Oct 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04S685 | CO | MD | In Home Supportive Care Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sand and Sage Personal Care Agency | In Home Supportive Care | Current |
Accepting new patients |
Locations
121 W Beech St
Lamar, CO 81052
Phone (719) 688-9666
117 W Elm St
Lamar, CO 81052
Phone (719) 691-1941
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 04S685 | CO | Yes |
Addresses
Primary practice location
117 W Elm St
Lamar, CO 81052-2701
Mailing address
117 W Elm St
Lamar, CO 81052-2701
Phone (719) 691-1941
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30854369 | Medicaid | CO |
Other names
- Ms. Jackie Rae Hiner
Other providers in Lamar, CO
- High Plains Community Health Center, Inc.
- High Plains Community Health Center, Incorporated
- High Plains Migrant
- Meagan L Hillman
- Hilton C Ray MDPC
- Julie Hobden
- Jeffrey Horgan
- Helen Drake Iams
- Celia A Ibanez
- Arin W Iman
All providers in Lamar, CO · In Home Supportive Care Agency in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.