Provider Demographics
NPI:1114609088
Name:MK LIVING, INC
Entity Type:Organization
Organization Name:MK LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANISE
Authorized Official - Middle Name:MACHELLE
Authorized Official - Last Name:POLUMBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-300-7719
Mailing Address - Street 1:7384 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2386
Mailing Address - Country:US
Mailing Address - Phone:720-300-7719
Mailing Address - Fax:
Practice Address - Street 1:17006 E OHIO DR APT 1-102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-3433
Practice Address - Country:US
Practice Address - Phone:720-300-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347E00000XTransportation ServicesTransportation BrokerGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care