Provider Demographics
NPI:1568236024
Name:MOUNTAIN VALLEY DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-230-9831
Mailing Address - Street 1:700 MOUNT SOPRIS DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4622
Mailing Address - Country:US
Mailing Address - Phone:970-945-2306
Mailing Address - Fax:970-945-6469
Practice Address - Street 1:700 MOUNT SOPRIS DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4622
Practice Address - Country:US
Practice Address - Phone:970-945-2306
Practice Address - Fax:970-945-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy