Healthcare Provider Details

I. General information

NPI: 1437399623
Provider Name (Legal Business Name): MOUNT ST. VINCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

IV. Provider business mailing address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANESSA WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-237-3660