Organization
COPPER MOUNTAIN INN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULA R MITCHELL NHA (ADMINISTRATOR)
(928) 425-5721
Entity
Organization
Contact information
Practice address
1100 E MONROE ST, GLOBE, AZ 85501-1363
(928) 425-5721
(928) 425-3745
Mailing address
1100 E MONROE ST, GLOBE, AZ 85501-1363
(928) 425-5721
(928) 425-3745
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI 412
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558471
—
AZ
Enumeration date
07/18/2005
Last updated
08/22/2020
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