Provider Demographics
NPI:1225474901
Name:MT ROSE HEALTH CENTER
Entity Type:Organization
Organization Name:MT ROSE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BORSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-846-8478
Mailing Address - Street 1:409 BENEDICTA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-0000
Mailing Address - Country:US
Mailing Address - Phone:719-846-8478
Mailing Address - Fax:719-846-2941
Practice Address - Street 1:409 BENEDICTA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-0000
Practice Address - Country:US
Practice Address - Phone:719-846-8478
Practice Address - Fax:719-846-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38779173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty