Provider Demographics
NPI:1306231642
Name:MESA VIEW RETIREMENT HOME INC.
Entity Type:Organization
Organization Name:MESA VIEW RETIREMENT HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INA
Authorized Official - Middle Name:LUJEANE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-749-0356
Mailing Address - Street 1:16200 ROAD 31
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328
Mailing Address - Country:US
Mailing Address - Phone:970-749-0356
Mailing Address - Fax:970-882-7997
Practice Address - Street 1:24760 COUNTY ROAD G
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-564-0716
Practice Address - Fax:970-564-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO231289310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04182176Medicaid