MEDICARE: MK LIVING, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	347E00000X	Transportation Broker
3	373H00000X	Day Training/Habilitation Specialist
4	376J00000X	Homemaker
5	385H00000X	Respite Care
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1114609088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK LIVING, INC

Provider Business Mailing Address
First Line	:	7384 E PRINCETON AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2386
Country	:	US
Telephone Number	:	720-300-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	17006 E OHIO DR APT 1-102
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-3433
Country	:	US
Telephone Number	:	720-300-7719
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DANISE MACHELLE POLUMBUS
Credential	:
Telephone Number	:	720-300-7719

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “MK LIVING, INC ” Practice Location

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