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General NPI Number Information
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NPI Number | 1962801423
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Entity Type | Organization
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Legal Business Name | MONTE VISTA ESTATES, LLC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 2277 EAST DR
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City | MONTE VISTA
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State | CO
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Zip | 81144-9330
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Country | US
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Telephone | 719-852-5138
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Fax | 719-852-4012
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Provider Business Mailing Address
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Address Line | 2277 EAST DR
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City | MONTE VISTA
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State | CO
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Zip | 81144-9330
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Country | US
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Telephone | 719-852-5138
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Fax | 719-852-4012
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. KENT M EMRY
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Credential |
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Telephone | 503-689-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | APPLIED FOR
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License Number State | CO
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