Organization
STATE OF COLORADO
Active
Other names
Colorado Veterans Community Living Center Homelake
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MINDY MONTAGUE (ADMINISTRATOR)
(719) 852-5118
Entity
Organization
Contact information
Practice address
3749 SHERMAN AVE, MONTE VISTA, CO 81144-9403
(719) 852-5118
(719) 852-3881
Mailing address
PO BOX 97, HOMELAKE, CO 81135-0097
(719) 852-5118
(719) 852-3881
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2023
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05653274
—
CO
Enumeration date
12/05/2006
Last updated
07/12/2021
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