MEDICARE: SOLTERRA MOUNTAIN VIEW SENIOR LIVING, LLC

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	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility	020546	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215259577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLTERRA MOUNTAIN VIEW SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	2612 WEST CUCHARRAS STREET
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-632-7474
Fax Number	:	719-635-0058

Provider Business Practice Location Address
First Line	:	2612 WEST CUCHARRAS STREET
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-632-7474
Fax Number	:	719-635-0058

Authorized Official
Title or Position	:	NHA DIRECTOR OF COLORADO OPERATIONS
Name	:	MR. GERARD R LAFONT
Credential	:	NHA
Telephone Number	:	303-688-3174

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	05/13/2011

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