Provider Demographics
NPI:1053819045
Name:MOUNTAIN FAMILY HEALTH CENTERS
Entity Type:Organization
Organization Name:MOUNTAIN FAMILY HEALTH CENTERS
Other - Org Name:MOUNTAIN FAMILY HEALTH CENTERS MOBILE DENTAL VAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANTA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:970-928-1636
Mailing Address - Street 1:2700 GILSTRAP CT STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8735
Mailing Address - Country:US
Mailing Address - Phone:970-945-2840
Mailing Address - Fax:970-945-9581
Practice Address - Street 1:1905 BLAKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4206
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:970-945-2893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN FAMILY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)