Provider Demographics
NPI:1760148829
Name:MOUNTAIN RIDGE HOSPICE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN RIDGE HOSPICE, LLC
Other - Org Name:MOUNTAIN RIDGE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-418-3475
Mailing Address - Street 1:3204 N ACADEMY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5162
Mailing Address - Country:US
Mailing Address - Phone:719-418-3475
Mailing Address - Fax:
Practice Address - Street 1:3204 N ACADEMY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5162
Practice Address - Country:US
Practice Address - Phone:505-238-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based