Provider Demographics
NPI:1437916533
Name:MLS ASSISTED LIVING CC LLC
Entity Type:Organization
Organization Name:MLS ASSISTED LIVING CC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CONNER
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-314-2993
Mailing Address - Street 1:1000 N 9TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3107
Mailing Address - Country:US
Mailing Address - Phone:970-314-2993
Mailing Address - Fax:
Practice Address - Street 1:445 SANDIA DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1564
Practice Address - Country:US
Practice Address - Phone:970-314-2993
Practice Address - Fax:970-808-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility