State of Colorado
NPI #1114085875 in Monte Vista, Colorado
Provider Information
- NPI Number
- 1114085875
- Entity Type
- Organization
- Organization Name
- State of Colorado
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Dec 5, 2006
- Last Updated
- Jul 12, 2021
Practice Location
- Address
- 3749 SHERMAN AVE
- City
- Monte Vista
- State
- Colorado
- ZIP Code
- 81144-9403
- Phone
- (719) 852-5118
Authorized Official
- Name
- MS. MINDY MONTAGUE
- Title
- ADMINISTRATOR
- Phone
- (719) 852-5118
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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