Healthcare Provider Details

I. General information

NPI: 1811529571
Provider Name (Legal Business Name): MK LIVING OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7384 E PRINCETON AVE
DENVER CO
80237-2386
US

IV. Provider business mailing address

7384 E PRINCETON AVE
DENVER CO
80237-2386
US

V. Phone/Fax

Practice location:
  • Phone: 720-300-7719
  • Fax:
Mailing address:
  • Phone: 720-300-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DANISHA POLUMBUS
Title or Position: OWNER
Credential:
Phone: 720-300-7719