MEDICARE: MOUNT EVANS HOSPICE, INC.

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1962920207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT EVANS HOSPICE, INC.

Provider Business Mailing Address
First Line	:	3081 BERGEN PEAK DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2200
Country	:	US
Telephone Number	:	303-674-6400
Fax Number	:	303-674-8813

Provider Business Practice Location Address
First Line	:	3081 BERGEN PEAK DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2200
Country	:	US
Telephone Number	:	303-674-6400
Fax Number	:

Authorized Official
Title or Position	:	INTERIM PRESIDENT AND CEO
Name	:	LYDIA THANGAIYAN
Credential	:
Telephone Number	:	949-647-0423

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	02/06/2026

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