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General NPI Number Information
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NPI Number | 1073467270
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Entity Type | Organization
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Legal Business Name | MARY'S SECOND HALF, LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 1226 MILNER LN
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City | LONGMONT
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State | CO
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Zip | 80503-3631
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Country | US
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Telephone | 303-931-4095
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Fax |
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Provider Business Mailing Address
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Address Line | 1226 MILNER LN
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City | LONGMONT
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State | CO
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Zip | 80503-3631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER/SERVICE PROVIDER
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Name | MARY GRAEFF GOMEZ
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Credential |
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Telephone | 303-931-4095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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