Provider Demographics
NPI:1871827675
Name:LINDA GIBBONS, INC.
Entity Type:Organization
Organization Name:LINDA GIBBONS, INC.
Other - Org Name:SAGE MOUNTAIN WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-530-8218
Mailing Address - Street 1:14151 W CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5322
Mailing Address - Country:US
Mailing Address - Phone:720-530-8218
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR
Practice Address - Street 2:101
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2009
Practice Address - Country:US
Practice Address - Phone:720-530-8218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty