Healthcare Provider Details

I. General information

NPI: 1245128586
Provider Name (Legal Business Name): MISSION ARCH OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MISSION ARCH DR
ROSWELL NM
88201-8307
US

IV. Provider business mailing address

950 S CHERRY ST STE 716
DENVER CO
80246-2665
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-2583
  • Fax:
Mailing address:
  • Phone: 720-696-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AHRON KATZ
Title or Position: MANAGER
Credential:
Phone: 720-696-5431