Provider Demographics
NPI:1912460056
Name:MOUNTAIN VIEW RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-651-7584
Mailing Address - Street 1:5475 MARK DABLING BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3847
Mailing Address - Country:US
Mailing Address - Phone:973-277-5359
Mailing Address - Fax:928-441-1686
Practice Address - Street 1:5475 MARK DABLING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3847
Practice Address - Country:US
Practice Address - Phone:973-277-5359
Practice Address - Fax:928-441-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder