Organization
MOUNTAIN HOME MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN NICHOLSON (OWNER)
(719) 331-9861
Entity
Organization
Contact information
Practice address
226 ILLINI DR, WOODLAND PARK, CO 80863-8747
(719) 686-7504
Mailing address
226 ILLINI DR, WOODLAND PARK, CO 80863-8747
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02800586
—
CO
Enumeration date
01/15/2007
Last updated
08/22/2020
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