# COPPER MOUNTAIN INN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851390330
- **Authorized official:** MRS. PAULA R MITCHELL NHA (ADMINISTRATOR)
- **Authorized official phone:** (928) 425-5721

## Contact information

- **Practice address:** 1100 E MONROE ST, GLOBE, AZ 85501-1363
- **Practice address phone:** (928) 425-5721
- **Practice address fax:** (928) 425-3745
- **Mailing address:** 1100 E MONROE ST, GLOBE, AZ 85501-1363
- **Mailing address phone:** (928) 425-5721
- **Mailing address fax:** (928) 425-3745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI 412 | AZ | Yes |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 558471 | — | AZ |