Provider Demographics
NPI:1306190244
Name:MOUNTAIN VIEW TENANT LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW TENANT LLC
Other - Org Name:BROOKDALE MOUNTAIN VIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPP-GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:8101 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1104
Mailing Address - Country:US
Mailing Address - Phone:303-369-0736
Mailing Address - Fax:
Practice Address - Street 1:8101 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1104
Practice Address - Country:US
Practice Address - Phone:303-369-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065392Medicare Oscar/Certification