Healthcare Provider Details

I. General information

NPI: 1306190244
Provider Name (Legal Business Name): MOUNTAIN VIEW TENANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 E MISSISSIPPI AVE
DENVER CO
80247-1104
US

IV. Provider business mailing address

8101 E MISSISSIPPI AVE
DENVER CO
80247-1104
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-0736
  • Fax:
Mailing address:
  • Phone: 303-369-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCO

VIII. Authorized Official

Name: GERI KRUPP-GORDON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 414-918-5000