MEDICARE: MOUNTAIN SUN ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1073208880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN SUN ENTERPRISES

Provider Business Mailing Address
First Line	:	6565 S DAYTON ST STE 2350
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-6140
Country	:	US
Telephone Number	:	720-821-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 S SHERMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3117
Country	:	US
Telephone Number	:	404-279-0719
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARC COKER
Credential	:
Telephone Number	:	404-279-0719

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	08/01/2024

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Directions to “MOUNTAIN SUN ENTERPRISES ” Practice Location

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