Healthcare Provider Details

I. General information

NPI: 1962801423
Provider Name (Legal Business Name): MONTE VISTA ESTATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 EAST DR
MONTE VISTA CO
81144-9330
US

IV. Provider business mailing address

2277 EAST DR
MONTE VISTA CO
81144-9330
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-5138
  • Fax: 719-852-4012
Mailing address:
  • Phone: 719-852-5138
  • Fax: 719-852-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KENT M EMRY
Title or Position: MANAGING MEMBER
Credential:
Phone: 503-689-1808